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Trends in Reconstructive Neurosurgery: Neurorehabilitation, Restoration and Reconstruction (Acta Neurochirurgica Supplement) 1st Edition

Trends in Reconstructive Neurosurgery: Neurorehabilitation, Restoration and Reconstruction (Acta Neurochirurgica Supplement) 1st Edition

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These proceeding cover new trends presented at the IV Congress of the International Society of Reconstructive Neurosurgery (ISRN), 2015. ISRN is an “open” multidisciplinary society that deals with advances in spine and peripheral-nerve reconstructive surgery, central nervous system revascularization (surgical, radio interventional), neuromodulation, bioengineering and transplantation, which are the latest tools used to promote reconstruction, restoration and rehabilitation.

Applied Cranial-Cerebral Anatomy: Brain Architecture and Anatomically Oriented Microneurosurgery

Applied Cranial-Cerebral Anatomy: Brain Architecture and Anatomically Oriented Microneurosurgery

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This book is the first to offer a comprehensive guide to understanding the brain’s architecture from a topographical viewpoint. Authored by a leading expert in surgical neuroanatomy, this practical text provides tri-dimensional understanding of the cerebral hemispheres, and the relationships between cerebral surfaces and the skull’s outer surfaces through detailed brain dissections and actual clinical cases with operative photographs and correlative neuroimaging. For neurosurgeons, neuroradiologists and neurologists at all levels, this book emphasises the anatomy of the sulci and gyri of the cerebral surface. It is an essential resource for the general neurosurgery practice, and more particularly for planning surgical access routes for intracranial tumors.

 

Neuroanatomy Books

Sorted By Relevance

Clinical Neuroanatomy Made Ridiculously Simple


Neuroanatomy through Clinical Cases


Neuroanatomy in Clinical Context: An Atlas of Structures, Sections, Systems, and Syndromes (Neuroanatomy: An Atlas of Strutures, Sections, and Systems


Neuroanatomy: an Illustrated Colour Text


BRS Neuroanatomy (Board Review Series)

Controversies in Spine Surgery, MIS versus OPEN: Best Evidence Recommendations

Controversies in Spine Surgery, MIS versus OPEN: Best Evidence Recommendations

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Master spine surgeons Alexander R. Vaccaro, Richard G. Fessler, and a cadre of esteemed co-editors have compiled the most comprehensive textbook to date detailing minimally invasive spine (MIS) versus open spine surgery techniques. Controversies in Spine Surgery, MIS versus OPEN: Best Evidence Recommendations features debates by renowned experts on one of the most provocative topics in spine surgery. Twenty-four chapters systematically organized into four sections — degenerative, trauma, tumor, and other issues, cover procedures and underlying pathologies, backed by a large, diverse body of literature.

MIS and open approaches are thoroughly compared and contrasted in each chapter. Evidence is presented and analyzed in an objective manner with ‘opposing sides’ presenting differing opinions and techniques, resulting in a synchronous collection of pros and cons. Every chapter is masterfully summed up by the book’s editors — each of whom have varying stances on the topics at hand. This unique ‘duel’ and ‘duet’ discussion enables readers to assimilate information, benefit from the balanced harmony between divergent opinions, and reach their own conclusions.

Key Highlights

  • Comparative risks, benefits, complications, and outcomes for a full spectrum of lumbar, thoracic and cervical procedures
  • MIS versus open approaches for lumbar stenosis, synovial cysts, lumbar adjacent segment degeneration, degenerative scoliosis, flatback syndrome, thoracic disc herniation, and dural tears
  • Tumor resection and stabilization, quality of life issues, and potential advantages and risks of MIS techniques
  • Key differences in MIS versus open operations such as radiation exposure and costs
  • Analysis of 3-D navigational imaging to improve outcomes and reduce radiation exposure and operating time

This book is a tremendous, evidence-based tool to guide spine surgeons as they make important decisions on selecting the most optimal spine surgery techniques. It is a must-have resource for all resident and veteran orthopaedic surgeons and neurosurgeons who specialize in treating patients with spine conditions.

Alexander R. Vaccaro, MD, PhD, FACS, MBA, is Richard H. Rothman Professor and Chairman, Department of Orthopaedic Surgery, and Professor of Neurosurgery, Thomas Jefferson University and Hospitals; and President, The Rothman Institute, Philadelphia, Pennsylvania, USA.

Richard G. Fessler, MD, PhD, is Professor, Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.

Faheem A. Sandhu, MD, PhD, is Professor of Neurosurgery, Director of Spine Surgery, and Co-Director, Center for Minimally Invasive Spine Surgery, Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.

Jean-Marc Voyadzis, MD, is Co-Director, Center for Minimally Invasive Spine Surgery and Associate Professor of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.

Jason C. Eck, DO, MS, is an Orthopaedic Spine Surgeon, Center for Sports Medicine and Orthopedics, Chattanooga, Tennessee, USA.

Christopher K. Kepler, MD, MBA, is an Associate Professor and Orthopaedic Spine Surgeon, Department of Orthopaedic Surgery, Thomas Jefferson University and Hospitals, and The Rothman Institute, Philadelphia, Pennsylvania, USA.

 

Update: Nicardipine

Nicardipine

Nicardipine was approved by the FDA in December 1988. The patent for both Cardene and Cardene SR expired in October 1995.

Nicardipine hydrochloride (Cardene) belongs to the class of calcium channel blockers.

It is available in oral and intravenous formulations.

see Intraventricular nicardipine.

Ampules contain 25 mg and must be diluted before.

Does not require arterial line. Does not produce intracranial hypertension. Does not reduce heart rate 1).

May be used in conjunction with e.g. labetalol or esmolol if that is desired.

Its mechanism of action and clinical effects closely resemble those of nifedipine and the other dihydropyridines (amlodipine, felodipine), except that nicardipine is more selective for cerebral and coronary blood vessels.

Furthermore, nicardipine does not intrinsically decrease myocardial contractility and may be useful in the management of congestive heart failure. Nicardipine also has a longer half-life than nifedipine. It has been used in percutaneous coronary intervention.

Indications

Intravenous nicardipine is commonly used for blood pressure reduction in patients with acute stroke.

see Nicardipine for aneurysmal subarachnoid hemorrhage.

Endovascular approaches with balloon angioplasty and intra-arterial nimodipine, nicardipine, and milrinone have shown consistent benefits 2).

Side effects

Headache

Nausea

Hypotension

Reflex tachycardia.

Phlebitis is significantly associated with administration of a maximum concentration of nicardipine greater than 130 µg/mL 3).

Intravenous nicardipine-related phlebitis was retrospectively analyzed. From July 2015, a simple proposition was made to dilute maximum intravenous nicardipine concentration to lower than 130 µg/mL. The maximum intravenous nicardipine concentration and the incidence of phlebitis were compared between patients treated from July 2014 to June 2015 (preproposition group) and patients treated from July 2015 to June 2016 (postproposition group).

A total of 300 patients (preproposition group, 138; postproposition group, 162) were included. The postproposition group demonstrated significantly lower maximum intravenous nicardipine concentration (in µg/mL, 76.9, 47.6-104.5 versus 130.4, 69.8-230.8; P < .001) and incidence of phlebitis (9.9%, 16/162 vs. 30%, 42/138; P < .001) than the preproposition group. Multivariable logistic regression analysis revealed that the maximum intravenous nicardipine concentration lower than 130 µg/mL (odds ratio [OR] .15; 95% confidence interval [CI] .06-.35; P < .001) and National Institutes of Health Stroke Scale on admission (OR .95; 95% CI .91-.99; P = .007) were the statistically significant independent factors for phlebitis, which indicated the usefulness of the proposition to dilute maximum intravenous nicardipine concentration to lower than 130 µg/mL.

The simple and appropriate proposition about nicardipine administration lowered maximum nicardipine concentration and reduced the incidence of nicardipine-related phlebitis in patients with acute stroke 4).

Dosing

IV: 5 mg/hr by slow infusion (50 mL/hr) initially; may be increased by 2.5 mg/hr every 15 minutes; not to exceed 15 mg/hr.

Off label 10 mg/hr may be used in situations where urgent reduction of arterial hypertension is needed.

Decrease to 3 mg/hr once control is achieved.

Effects on cerebrovascular hemodynamics

Few studies have described its effects on cerebrovascular hemodynamics as measured by transcranial Doppler (TCD) waveform analysis and pulsatility index (PI).

Lahiri et al., report examples of a consistent but paradoxical finding associated with nicardipine that suggests intracranial vasoconstriction, contrary to what is expected from a vasodilator.

The data presented are from a convenience sample of patients who underwent TCD monitoring before, after, or during nicardipine administration. In each case, TCD waveform morphologies and PIs were compared.

The TCD waveforms during nicardipine infusion are characterized by a prominent systolic peak and dicrotic notch. Systolic deceleration was more pronounced and PIs were significantly elevated in patients who were on nicardipine (p < 0.001). This finding was not evident when patients were not on nicardipine.

This study provides the first evidence of paradoxical intracranial vasoconstriction associated with intravenous nicardipine. In the authors’ experience, this finding is consistently encountered in the vast majority of patients who are treated with intravenous nicardipine, and is contradictory to what is expected from a vasodilator. Future studies are needed to confirm this finding in larger populations and diverse clinical settings and to examine mechanisms that explain this phenomenon 5).

1)

Badjatia N, Topcuoglu MA, Pryor JC, Rabinov JD, Ogilvy CS, Carter BS, Rordorf GA. Preliminary experience with intra-arterial nicardipine as a treatment for cerebral vasospasm. AJNR Am J Neuroradiol. 2004 May;25(5):819-26. PubMed PMID: 15140728.
2)

Rao GS, Muthuchellappan R. Cerebral vasospasm: current understanding. Curr Opin Anaesthesiol. 2016 Oct;29(5):544-51. doi: 10.1097/ACO.0000000000000370. Review. PubMed PMID: 27341013.
3)

Kawada K, Ohta T, Tanaka K, Kadoguchi N, Yamamoto S, Morimoto M. Risk Factors of Nicardipine-Related Phlebitis in Acute Stroke Patients. J Stroke Cerebrovasc Dis. 2016 Oct;25(10):2513-8. doi: 10.1016/j.jstrokecerebrovasdis.2016.06.028. Epub 2016 Jul 14. PubMed PMID: 27423368.
4)

Kawada K, Ohta T, Tanaka K, Miyamoto N. Reduction of Nicardipine-Related Phlebitis in Patients with Acute Stroke by Diluting Its Concentration. J Stroke Cerebrovasc Dis. 2018 Mar 5. pii: S1052-3057(18)30064-8. doi: 10.1016/j.jstrokecerebrovasdis.2018.02.013. [Epub ahead of print] PubMed PMID: 29519742.
5)

Lahiri S, Nezhad M, Schlick KH, Rinsky B, Rosengart A, Mayer SA, Lyden PD. Paradoxical cerebrovascular hemodynamic changes with nicardipine. J Neurosurg. 2018 Apr;128(4):1015-1019. doi: 10.3171/2016.11.JNS161992. Epub 2017 Apr 21. PubMed PMID: 28430036.