Main description:

Epilepsy surgery is defined as any neurosurgical intervention whose pri- mary objective is to relieve medically intractable epilepsy (European Fed- eration of Neurological Societies Task Force 2000). The aim of epilepsy surgery is to reduce the number and intensity of seizures, minimise neuro- logical morbidity and antiepileptic drug (AED) toxicity, and improve quality of life. By definition, epilepsy surgery does not include normal surgical treatment of intracranial lesions where the primary goal is to di- agnose and possibly remove the pathological target, often an advancing tumour. In these patients, epileptic seizures are only one symptom of the lesion and will be treated concomitantly as part of the procedure. Temporal lobe epilepsy (TLE) is recognised as the most common type of refractory, focal epilepsy. In one third of all cases the neuronal systems responsible for the seizures that characterise this form of epilepsy fail to respond to currently available AEDs (Andermann F 2002). New imaging methods, especially magnetic resonance imaging (MRI), identify localising abnormalities in an increasing proportion of patients with intractable focal epilepsy.
Consequently, the accuracy of the preoperative diagnostic pro- cedures has been significantly improved during the last decade; and suit- able candidates for surgery can be selected more reliably. Currently the main resources in most epilepsy surgery centres have been used to evaluate candidates for TLE surgery.

Contents:

A. Advances.- Disorders of Consciousness: Anatomical and Physiological Mechanisms.- Abstract.- The Wake-Sleep Cycle.- Phenomenology.- Regulation.- Wakefulness Network.- The Posterior Hypothalamus.- Histamine Network.- Orexin/Hypocretin Network.- Brainstem Acetylcholine and Amine Networks.- The Serotonin System.- Tentative Functions of the Wake System.- Effect of Sleep Deprivation on Cognitive Performances.- References.- Advances in Craniosynostosis Research and Management.- Abstract.- Normal Craniofacial Embryology and Growth.- Aetiology, Pathogenesis and Function.- Classification and Diagnosis.- Evolution of Surgical Treatment.- Recent Advances.- Molecular Studies.- Imaging Techniques and Surgical Planning.- Resorbable Fixation.- Bone Substitutes and Tissue Engineering.- Distraction Osteogenesis and the Spring-Mediated Cranioplasties.- Resorbable Distractor Devices.- Minimally Invasive Surgery.- In Utero Surgery.- Surgical Techniques.- Sagittal Synostosis.- Unicoronal Synostosis.- Metopic Synostosis.- Unilambdoid Synostosis.- Bicoronal Synostosis.- Saethre-Chotzen Syndrome.- Crouzon and Pfeiffer Syndromes.- Apert Syndrome.- References.- B. Technical Standards.- Preoperative Clinical Evaluation, Outline of Surgical Technique and Outcome in Temporal Lobe Epilepsy.- Abstract.- Epidemiology of Temporal Lobe Epilepsy (TLE).- Etiology and Pathology of TLE.- Temporal Lobe Seizure Symptomatology.- Mesial TLE.- Neocortical TLE.- Selection of Candidates for Preoperative Assessment.- Neuropsychological Evaluation in TLE.- WADA Test.- Magnetic Resonance Imaging (MRI) in TLE.- Volumetry.- NMR-Spectroscopy.- Lesions in MRI.- Functional MRI.- EEG-Videotelemetry in TLE.- Interictal EEG.- Diagnostic EEG-Videotelemetry.- Intracranial EEG-Monitoring in TLE.- Indications for Intracranial EEG.- Intracranial EEG-Recording in Videotelemetry.- Surgical Technique for Inserting the Electrodes.- Complications of Invasive EEG-Monitoring.- Functional Imaging in TLE.- Positron Emission Tomography, PET.- Single Photon Emission Computed Tomography, SPECT.- Magnetoencephalography, MEG.- Indications for Surgery in TLE.- Surgery in Patients with Temporal Lobe Lesions.- Technique of Tailored Temporal Lobe Resection with Amygdalo-Hippocampectomy.- Peroperative Electrocorticography.- Outcome of Surgery with Respect to Seizures.- Complications.- Conclusions.- Acknowledgemen.- References.- Motor Evoked Potential Monitoring for Spinal Cord and Brain Stem Surgery.- Abstract.- I: Intraoperative Neurophysiological Techniques.- The Past.- Historical Background on MEP Monitoring.- Misconceptions about MEP Monitoring.- The Present.- MEP Monitoring Techniques for Spinal Cord and Brainstem Procedures.- Transcranial Electrical Stimulation of the Motor Cortex and Muscle Recordings (Multipulse Technique).- Transcranial Electrical Stimulation of the Motor Cortex and Epidural Recordings (Single Pulse Technique).- Mapping of the Corticospinal Tract During Brainstem Procedures.- The "Future".- Mapping of the Corticospinal Tract During Spinal Cord Procedures: The Collision Technique.- Monitoring of the Corticobulbar Tracts.- II: Clinical Application.- Correlation Between Intraoperative MEP Recordings and Post-Operative Motor Outcome.- How to Avoid Irreversible MEP Loss.- Warning Signals.- Corrective Measures for the Management of Deteriorating Signals.- Dose MEP Monitoring Really Make a Difference?.- Illustrative Cases.- Conclusions.- References.- Acknowledgments.- Motor Evoked Potential Monitoring for the Surgery of Brain Tumours and Vascular Malformations.- Abstract.- Direct Stimulation Mapping.- Evoked Potentials.- Motor Evoked Potentials.- MEP Technique.- Stimulation.- Recording.- Safety and Anesthesia.- Equipment and Staffing.- Neurophysiological Functional Mapping of the Pericentral Cortex.- SEP Phase Reversal.- Intraoperative Stimulation Mapping.- Extraoperative Mapping with Grid Electrodes.- Principles of Clinical Application.- Indications for MEP Monitoring.- Interpretation of MEP Changes.- Correlation of Intraoperative MEP Changes and Motor Outcome.- Surgical Reactions to MEP Changes.- Influence of MEP Monitoring on Surgical Results and Outcome.- Specific Applications.- Supratentorial Tumors and Vascular Malformations.- Central Tumors and AVMs.- Insular Tumors and Sylvian AVMs.- Infratentorial Surgery.- Indications for MEP Monitoring.- Impact on Surgical Strategy.- Clinical Experience with MEP Monitoring for Infratentorial Surgery.- Aneurysms.- SEP Monitoring for Aneurysm Surgery.- Conduction of MEP Monitoring for Aneurysm Surgery.- Clinical Experience.- Clinical Relevance of Aneurysm Monitoring.- Summary and Conclusions.- Why MEP Monitoring?.- When to Perform MEP Monitoring?.- How to Achieve Good MEP Monitoring?.- How to Assess and Interpret MEPs?.- Does MEP Monitoring Influence Surgical Strategy and Postoperative Outcome.- References.- Functional Neuronavigation and Intraoperative MRI.- Abstract.- Functional Neuronavigation.- Magnetoencephalography.- Functional MRI.- Clinical Impact of Functional Imaging.- Comparing MEG/fMRI.- Intraoperative Imaging.- Low-Field MR Imaging.- Clinical Experience.- Pituitary Tumour Surgery.- Glioma Surgery.- Epilepsy Surgery.- Limitations and Imaging Alternatives.- High-Field MR Imaging.- Integration of a High-Field Scanner into the Operating Room.- First Clinical Results.- Summary & Future Developments.- Acknowledgments.- References.- Surgical Anatomy of the Insula.- Summary.- Descriptive Anatomy [33, 39].- The Borders of the Insula.- The Insular Cortex (Fig. 7).- Relationships (Figs . 8-12).- The Association Fibers.- Short Association Fibers.- Long Ipsihemispheric Association Fascicles.- Vascular Anatomy (Figs. 13-15).- Arterial Relationships.- Veins.- Functional Anatomy.- Connections (Fig . 17) [l, 17, 18].- Physiological Roles of the Insula [1-3, 13, 14, 22, 23, 27].- Insula and Pain.- The Insula and Epilepsy Surgery.- Tumoral Surgery in the Insular Region.- Conclusion.- References.