bluuebunny/crossref_metadata_2025 huggingface dataset:
Emotional Roller Coasters
Authors: Klitzman Robert L.
Published: October 2019

Patients face stresses from not only infertility procedures themselves but also the psychological and social aspects of these interventions, including uncertainties, failures, costs, and loss of dreams. These physical, social, psychological, financial, and moral strains can exacerbate each another. Patients who quickly succeed in getting a “take-home baby” generally feel pleased with their treatment. But treatment failures can mean loss of purpose, identity, hopes, and dreams, thus embittering, confusing, and disturbing patients. Doctors may be overly optimistic, fueling eventual patient disappointments. Couples can disagree over how much effort, money, and time to spend in trying to have a healthy child—how to weigh medical odds against financial and psychological costs. External supports range from negative to positive and from weak to strong. Well-meaning outsiders may offer suggestions that patients feel are unhelpful. These reproductive journeys can strain marriages, friendships, and jobs. Communication about these issues can help but be difficult.
Designing Our Future World
Authors: Klitzman Robert L.
Published: October 2019

The providers’ and patients’ experiences presented here reveal how powerful technological advances can shape current and future human lives in profound and at times unexpected ways, with critical medical as well as psychological, social, cultural, familial, moral, existential, and financial implications. In the infertility industry, laissez-faire market capitalism, with little regulation, has created a “Wild West.” At the same time, these rapidly advancing technologies remain expensive and not available to everyone, widening disparities between rich and poor and raising key questions about social justice—from access to care to eugenics. As we evolve ever further into these brave new worlds, the individuals here, wrestling with these conundrums today, can benefit us all.
Pedophilic Disorder
Authors: Fedoroff J. Paul
Published: October 2019

Abstract: This chapter examines pedophilic disorder, which is defined as a condition lasting at least 6 months consisting of recurrent, intense sexual arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally aged 13 years or younger) or simply as a sexual preference for boys or girls or both, usually of prepubertal or early pubertal age. The Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases diagnostic criteria for pedophilia are presented and discussed in this chapter. Reporting requirements and treatments are also discussed. Reasons for reconceptualizing the prognosis of this disorder are presented. The chapter also presents a review of the recent literature on these topics.
Sexual Masochism and Sexual Sadism Disorder
Authors: Fedoroff J. Paul
Published: October 2019

Abstract: Sexual sadism and masochism encompass a wide range of sexual interests. The words “sadism” and “masochism” are also used to describe nonsexual situations. In this chapter, the concepts of sadism and masochism are discussed as they relate both to sexual sadism disorder and sexual masochism disorder and also to bondage and discipline, dominance and submission, sadism and masochism (BDSM). This chapter reviews the Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases diagnostic criteria for sadism and masochism and discusses their difference from consensual BDSM. Variations are presented. Treatments and prognosis are discussed. A review of the recent literature on these topics is presented.
Voyeuristic Disorder
Authors: Fedoroff J. Paul
Published: October 2019

Abstract: Voyeuristic disorder is defined as a condition in which a person experiences persistent (at least 6 months), recurrent, and intense sexual arousal from observing an unsuspecting person who is naked, disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors. The prevalence of true voyeuristic disorder is estimated to be as high as 12% in men and 4% in women. This chapter discusses the Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases diagnostic criteria for voyeuristic disorder, in addition to its diagnosis, treatment, and prognosis. The recent literature on these topics is reviewed.
Other Specified Paraphilic Disorders
Authors: Fedoroff J. Paul
Published: October 2019

Abstract: The Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has a category of disorders termed “other specified paraphilic disorders” (OSPD). The DSM-5 diagnostic criteria for these disorders are contradictory, on the one hand referring to symptoms characteristic of a paraphilic disorder and, on the other hand, referring to symptoms that do not meet the full criteria for any of the disorders in the paraphilic disorders class. In this chapter, paraphilias meeting diagnostic criteria for OSPD are presented and discussed. Telephone scatologia, necrophilia, and zoophilia are briefly discussed, and the recent literature on these topics is reviewed.
Putting It All Together
Authors: Fedoroff J. Paul
Published: October 2019

Abstract: Unconventional sexual interests and behaviors can be classified in four ways. The system that appeals most to each person depends on the person’s background and preferred working paradigm. Those who think of paraphilias from a medical perspective will tend to think of possible anatomic or physiologic pathologies. Those who think of paraphilias from a behavioral perspective will tend to think of learned interests and behaviors due to mechanisms such as unconditioned and conditioned primary and second-order responses, blocking, generalization, punishment, and extinction. Those who think of paraphilias as variations on the range of sexual interests and behaviors shared by diverse population samples of humans will be prone to depathologize paraphilias and avoid categories. Those who focus on understanding the meaning that the paraphilia has for the person with the paraphilia will tend to think in terms of the person’s life history. This chapter reviews perspectives and paradigms concerning the paraphilias. A new classification scheme for the paraphilias is presented. The benefits of a new paradigm for the paraphilias that explains the changes seen in people with paraphilias is presented. A plea is made for productive future collaborations.
Principles of Surgical Palliative Care
Authors: Mosenthal Anne C.
Published: October 2019

The principles of surgical palliative care, an emerging field, represent the integration of surgical care and palliative care and their ethics, drawing on both disciplines to yield a more patient-centered approach to quality care. The core principle focuses on improving quality of life for those patients with serious illness and surgical disease or under the care of surgeons. Surgical palliative care addresses relief of suffering and shared decision-making across the life span, regardless of prognosis, and thus goes beyond end-of-life care and hospice. The chapter defines the principles of surgical palliative care, their ethical foundation, and their application in practice.
Perioperative DNR
Authors: Nagengast Andrea K. , Brasel Karen J.
Published: October 2019

Despite a diagnosis of a terminal or life-limiting illness, a patient’s do not resuscitate (DNR) status does not preclude the right to surgical intervention. There are many instances when operative intervention is appropriate and warranted. Often a patient is already in the palliative phase of his or her advanced disease process when addressing perioperative DNR status becomes necessary. A standardized framework, rather than rigid policy, not only utilizes shared decision-making to achieve this goal, but also ultimately enables a just process for each individual patient. Such a framework should include requirements for reevaluation; clarification of responsibilities surrounding reevaluation; resuscitation options (full, goal directed, procedure directed, none); documentation requirements; time limitations; and resources.
Palliative Care in Burn and Thermal Injury
Authors: Savetamal Alisa , Edwards Kristin
Published: October 2019

Burn injury can be a life-changing event for many patients, requiring prolonged hospitalization, multiple operative procedures, and extensive physical rehabilitation after hospital discharge. For the burn team, the challenges of caring for burn injuries are compounded by the psychosocial needs of the patients, many of whom have underlying medical, psychiatric, or substance abuse problems or some combination of all of these. Integrating palliative care services into the burn team is a valuable adjunct for the patients, families, and care teams involved in burn injury. Palliative care provides a framework for considering not only the acute needs of the burn patient but also the other underlying issues that may affect the patient’s hospital course, recovery, and long-term goals.
Clinical assessment
Authors: Bodkin Peter , Visser Elizabeth
Published: October 2019

The practical process of clinical assessment in modern neurosurgery is slightly different to the traditional model, and the history and examination provide the foundation stones on which all subsequent patient management is built. This chapter outlines the importance of the initial clinical encounter. History taking, including dealing with difficult consultations, is explored. The neurological examination pays particular attention to aspects relevant to neurosurgical practice from first impressions, assessment of the unconscious patient, speech and language, examination of individual lobes of the brain, cranial nerves including the eye examination, and limb examination. Finally, advice on how to pull this information together to make diagnostic conclusions and construct an appropriate management plan is provided.
High-grade gliomas and molecular biology of neurosurgical oncology
Authors: Price Stephen J , Bulstrode Harry , Mair Richard
Published: October 2019

The term high-grade glioma (HGG) encompasses a number of histological entities that are considered by the WHO Classification as WHO Grade III and IV tumours. They have traditionally been considered as having similar behaviour and had been treated in a similar manner but recent advances in our understanding of tumour biology have led to the identification of molecular markers that are now central to the classification of these tumours. Normal human cells develop into cancer cells through a stepwise accumulation of genomic and epigenomic alterations and this chapter considers the molecular markers of gliomas and explains their significance before going on to discuss the optimal management.
Dermoid and epidermoid cysts
Authors: McEvoy Andrew
Published: October 2019

Dermoid and epidermoid cysts are important intracranial developmental lesions. They are commonly derived from retained surface ectoderm trapped by two fusing neuroectodermal surfaces during neural tube closure, and are also termed congenital ectodermal inclusion cysts. Occasionally epidermoid cysts are acquired lesions derived from iatrogenic implantation of surface ectoderm (termed implantation dermoids). Dermoid cysts are rare, usually midline lesions that present early; these include dermoid structures and may rupture, causing meningitis. Epidermoids are usually lateral, slightly more common, and present later. Radiologically these lesions are characterized by restricted diffusion on MRI which distinguishes them from arachnoid cysts. Treatment is usually surgical with complete or subtotal resection of the cyst, the need for long-term follow-up is controversial.
Esthesioneuroblastoma
Authors: Klironomos Georgios , Gonen Lior , Gentili Fred
Published: October 2019

Esthesioneuroblastomas (ENB) are rare malignant tumours of neuroepithelial origin arising from the olfactory mucosa. Not uncommonly they metastasize to regional lymph nodes and distant organs. Commonly they have a long and insidious course and the diagnosis requires a high index of suspicion. Since this tumour was first described, many grading and staging systems have been proposed but still there is some controversy on which correlates best with tumour prognosis. The classic treatment for ENB is craniofacial resection with the goal of gross total resection and achievement of tumour-free margins. The enormous advances in endoscopic techniques over the last two decades means this now has comparable results in achieving tumour-free margins, especially for low stage tumours. The role of preoperative and postoperative radiation has been well established in the treatment of this tumour. Controversy exists regarding the role of neck dissection or elective neck radiation as standard therapeutic modalities.
Pituitary tumours
Authors: Gnanalingham Kanna , Zador Zsolt , Kearney Tara , Roncaroli Federico , Gattamaneni H. Rao
Published: October 2019

The pituitary gland occupies the sella turcica, approximately 5 cm posterior to the tip of the nose in the midline of the skull base. It is closely related to the hypothalamus and third ventricle superiorly, chiasm and lamina terminalis anterosuperiorly, sphenoid sinus anteroinferiorly, cavernous sinus and cavernous segment of the carotid artery laterally, the posterior clinoids and clivus posteriorly. There are two distinct components to the pituitary gland, the anterior and posterior lobe, which are derived from the ectoderm and neuroectoderm, respectively. The anterior pituitary constitutes 80% of the gland mass and in the horizontal plane it is distributed into two lateral wings. The hormones produced by the anterior pituitary are adrenocorticotropic hormone, prolactin, growth hormone, thyroid-stimulating hormone, follicle-stimulating hormone, and luteinizing hormone. This chapter looks in detail at the role of the pituitary gland, what happens when it becomes tumorous, and the recommended treatment avenues.
Medulloblastoma
Authors: Rutka James
Published: October 2019

Under the term embryonal tumours, we examine the malignant neoplasms medulloblastomas, CNS-PNETs, AT/RTs, and ETANTRs. The common histological link between them is the small, round, blue cells which appear on H&E stains. They are considered highly malignant tumours (WHO Grade IV), although significant variation of prognosis exists between the different subtypes. Current classification is based on their histopathological features. Advances on understanding of the molecular biology and behaviour of their cellular lines, has dramatically changed their stratification and scientific approach. Combination of surgical treatment with new schemes of adjuvant chemo- and radiotherapy offers improved survival rates but comes with a high cost on neurocognitive, endocrine, and overall functional status. New therapies with molecular targets will hopefully improve outcomes with minimal side effects and collateral damage.
Ependymoma
Authors: Chandler Christopher
Published: October 2019

Ependymomas which include both subependymoma and myxopapillary ependymoma variants are slow growing tumours of glial origin, believed to arise from radial glial stem cells within the ependymal surface within the central nervous system and spinal cord. Consequently, they are most commonly found in association with a ventricular surface, primarily within the fourth ventricle. Most of these tumours occur in children, representing approximately 10% of all paediatric central nervous system tumours, following astrocytomas and primitive neuroectodermal tumours in frequency, and there does not appear to be a gender bias. The majority of paediatric ependymomas are intracranial and about half occur in children less than 5 years old.
Surgical approaches to posterior fossa tumours
Authors: Morcos Jacques J. , Khan Osaama , Shah Ashish H.
Published: October 2019

Lesions of the fourth ventricle and foramen magnum can be difficult to manage surgically due to their proximity to critical brainstem structures. Understanding the anatomy of the fourth ventricle, lower cranial nerves, and basilar cisterns remains paramount for deciding surgical approaches to this location. Detailed preoperative workup and planning are necessary to minimize surgical morbidity and maximize tumour resection. This chapter provides an overview of the relevant anatomy and surgical techniques for lesions in the posterior fossa, specifically the fourth ventricle the foramen magnum. We will split this chapter into two main sections: microsurgical approaches to the fourth ventricle and skull base approaches to the foramen magnum.
Choroid plexus tumours
Authors: Roth Jonathan , Dvir Rina , Constantini Shlomi
Published: October 2019

Choroid plexus tumours (CPT) are relatively rare and include three pathological subtypes: papilloma (CPP) (benign); carcinoma (CPC) (malignant); atypical papilloma (ACPP) (intermediate). Most cases of CPT occur during early childhood and infancy; however, occurrence at all paediatric ages as well as adulthood has been documented.

The main treatment of CPT is surgical, aiming for complete resection in all subtypes of CPT. The location and vascularity of CPT present a special surgical challenge. Surgical excision of CPP can be curative. In the malignant CPC form, adjuvant chemotherapy is indicated. The role of radiotherapy is controversial. A subset of patients with CPT harbour germline or somatic TP53 mutations characterized by greater tumour aggressiveness and decreased survival.
Surgical management of intraventricular lesions
Authors: Ribas Guilherme , Ribas Eduardo , Kirollos Ramez W.
Published: October 2019

Deep understanding of neuroanatomy is mandatory in planning and execution of surgery for intraventricular lesions. These operative procedures include both open and endoscopic approaches, and choosing the appropriate trajectory to the various parts of the ventricles can minimize the resulting morbidity of the approach, which may occur in addition to the potential risk to the surrounding structures during resection of the lesion itself. The use of the natural spaces provided by the cerebral fissures and sulci allows access to the ventricular cavities whenever possible, however, traversing neural tissue eventually is inevitable. The juxta-midline location of the frontal horns and body of the lateral ventricle and the third ventricle allows the use of interhemispheric approaches. On the other hand, transcortical/trans-sulcal approaches are necessary for lesions located within the atrium or temporal horns of the lateral ventricle. In planning these approaches not only exquisite knowledge of the functional anatomy of the cortex is required, but also understanding the subcortical architecture of the white matter fibres to choose the safest rather than just the shortest route. Furthermore, appreciating the potential morbidity from injuring the surrounding intra- and peri-ventricular structures and awareness of the blind spots related to the various trajectories cannot be underestimated. Surgery for fourth ventricular lesions is covered elsewhere.
Surgical management of pineal region lesions
Authors: Woernle Christoph M. , Bernays René L. , de Tribolet Nicolas
Published: October 2019

Lesions in the pineal region are topographically located in the centre of the brain in the diencephalic-epithalamic region. An area where the brain is bounded ventrally by the quadrigeminal plate, midbrain tectum, and in-between the left and right superior colliculi, dorsally by the splenium of the corpus callosum, caudally by the cerebellar vermis and rostrally by the posterior aspects of the third ventricle. Major anatomical and surgical challenges are the vein of Galen located dorsally, the precentral cerebellar vein caudally, the internal cerebral veins anteriorly and the basal vein of Rosenthal laterally. Most pineal region tumours can be safely removed by both approaches depending on the surgeon’s experience: the occipital transtentorial approach is recommended in presence of associated hydrocephalus or a steep straight sinus and low location of the tumour and the supracerebellar infratentorial approach for posterior third ventricle tumours.
Neurophakomatoses
Authors: Greenway Fay , Elmslie Frances , Jones Timothy
Published: October 2019

The term phakomatosis, from the Greek root phakos, meaning lens or spot, was first used in 1920 to describe a group of multisystem disorders with common neuro-oculocutaneous findings. Each condition is caused by distinct genetic defects, with some overlap in terms of protein function. They share pathogenetic mechanisms in dysfunction of a tumour suppressor gene. This chapter details four of the phakomatoses seen in practice—neurofibromatosis types 1 and 2, tuberous sclerosis complex, and von Hippel-Lindau—paying attention to their neurological sequelae and impact on neurosurgical practice. For each condition, the epidemiology, genetics, diagnostic criteria, screening, clinical features, management, and controversy will be reviewed, with an accompanying illustrative case.
Intensive care management of head injury
Authors: Kirkman Matthew A. , Smith Martin
Published: October 2019

This chapter provides an overview of the early and intensive care management of traumatic brain injury (TBI), with a focus on interventions designed to optimize cerebral and systemic physiological variables in order to minimize secondary brain injury and systemic complications. Importantly, it has become increasingly apparent that intracranial and cerebral perfusion pressure monitoring alone cannot detect all instances of cerebral compromise. There has thus been a shift towards the use of multimodality neuromonitoring to provide early warning of cerebral hypoxia/ischaemia and guide timely and targeted interventions that aim to improve outcomes after TBI. Further research is required to establish the role of many of the interventions that are currently considered routine aspects of the management of TBI.
Complications of head injury
Authors: Afshari Fardad T. , Belli Antonio , Whitfield Peter C
Published: October 2019

Traumatic brain injury is a potentially devastating condition that affects many young adults and is increasingly seen in older people. In addition to initial insult to the neuronal tissue at the time injury, patients with traumatic brain injury may suffer from many physical and psychological complications. These complications further protract the path of recovery and pose challenges in treatment of this group of patients. In this chapter we aim to discuss early and late phase complications following traumatic brain injury and summarize the role of neurorehabilitation in the care of patients with head injury, with the understanding that classification by timing is an inexact science and there is considerable overlap between early and late complications.
The pathophysiology of subarachnoid haemorrhage
Authors: McMillen Jason
Published: October 2019

Aneurysm rupture with subarachnoid haemorrhage is the most devastating complication of intracerebral aneurysms. Grading the severity of the haemorrhage assists with prognostication and assists with decision-making for patient management. Both radiological and clinical grading systems can be predictive of outcomes following subarachnoid haemorrhage. The pathophysiology of, and risk factors for, intracerebral aneurysm formation, growth, and rupture are complicated and poorly understood. In order to make an informed judgement about which patients to treat, it is important to balance the natural history of the condition against each patient’s risks of treatment. Numerous risk factors for aneurysm rupture have been identified, and this quantification of risk continues to be refined. Cerebral vasospasm is a common complication after subarachnoid haemorrhage. The pathological mechanisms of vasospasm involve numerous changes acting in concert to result in ischaemic neurological deficits. Clinical and radiological monitoring allows early detection and treatment to prevent ischaemic neurological deficits.
Management of subarachnoid haemorrhage
Authors: Lawton Michael , Walcott Brian P. , Rodriguez Roberto
Published: October 2019

Subarachnoid haemorrhage resulting from a ruptured cerebral aneurysm requires advanced medical and surgical care to maximize patient outcomes. In the acute period, care is focused on rapid diagnosis and repairing the aneurysm with either clipping or coiling to prevent further haemorrhage. In the days to weeks that follow, the focus shifts to optimizing cerebral perfusion in order to prevent delayed ischaemia. Patients are best served by a multimodality team that can weigh the risks and benefits of treatment based on aneurysm characteristics, clinical scenario, best available evidence, and provider skill level. While controversy exists over various treatment modalities and management protocols, widespread advances in surgical and endovascular techniques and vasospasm care continue to decrease morbidity and mortality associated with this challenging disease.
Extracranial-intracranial bypass for cerebral ischaemia
Authors: Guilfoyle Mathew R , Kirkpatrick Peter J
Published: October 2019

Symptomatic stenosis or occlusion of the cervical (C1) internal carotid artery (ICA) is best addressed surgically with direct endarterectomy or thrombectomy procedures. This strategy is not usually possible for more distal lesions, and restoring brain perfusion requires diversion of blood from the extracranial to intracranial circulation with a variety of indirect and direct bypass techniques. However, despite five decades of experience and technical refinement, extracranial-intracranial (EC-IC) bypass for cerebral ischaemia remains contentious. This chapter looks at the conflicting bodies of evidence and opinion regarding how best to select patients for surgery, and asks whether there is meaningful clinical benefit with the surgical options available.
Surgical principles in spinal surgery
Authors: Thomson Simon , Derham Chris , Selvanathan Senthil
Published: October 2019

This chapter is an introduction to spinal surgery, specific surgical techniques will be covered in other chapters. Preoperative considerations include the need for effective preoperative patient selection and careful consent. The optimal management of antiplatelet drugs and low molecular weight heparins in patients having spinal surgery is discussed but remains unclear. Perioperative considerations include careful patient positioning to protect the eyes and other pressure areas as well as the accurate marking of levels using X-ray. The use of microscopes and neurophysiology in spinal surgery is also discussed. The importance of fusion and the techniques used to promote it are covered in this chapter. Screw, rod, and plate design is explained. The principles of minimal access surgery down tubes or with dedicated implant kits is also considered. Postoperative considerations include the place of physiotherapy and venous thromboembolism avoidance.
Spinal stability
Authors: Loughenbury Peter R , Hall Richard M
Published: October 2019

The vertebral column is a series of bones that connect the head to the pelvis, supported by a complex arrangement of muscles and ligaments. Regional variation in the anatomy of the column affords protection for the spinal cord, provides stability and mobility, and allows transmittance of movement to the lower limbs. When subjected to forces and displacements the column is uniquely adapted to provide the balance of stability and mobility necessary for upright posture and locomotion. Abnormal loading can cause a failure of the column through a bony or soft tissue injury. This can lead to clinical instability—a failure of the spine to maintain normal physiological loads without undue pain, deformity, or neurological injury. The concepts of spinal biomechanics and spinal instability are central in the decision-making processes following spinal trauma and underpin the understanding of pathological conditions of the spine and their surgical treatment.
Cervical spinal disease
Authors: Furtado Navin , Tsermoulas Georgios , Silva Adikarige Haritha Dulanka
Published: October 2019

Degenerative cervical spinal disease refers to neck pain, myelopathy, and/or radiculopathy. It is a common problem with increased prevalence above the age of 55 years. Understanding the natural history and pathophysiology is crucial in selecting patients for surgery. The degenerative pathological processes that can occur in the cervical spine include degenerative disc disease, degenerative cervical myelopathy, ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF). There are also systemic diseases affecting the cervical spine and these include rheumatoid disease, sero-negative spondyloarthropathies and diffuse idiopathic skeletal hyperostosis (DISH). This section describes the pathology of cervical spinal disease, the clinical management, surgical approaches, and controversies in the field.
Spinal cerebrospinal fluid dynamics
Authors: Flint Graham
Published: October 2019

Cerebrospinal fluid (CSF) within the spinal canal is far from a stagnant column of liquid, simply bathing the spinal cord, but is constantly being subjected to waves of energy, produced by both the cardiac and the respiratory cycles. Moreover, the spinal subarachnoid channels are normally in free communication with the intracranial basal cisterns and volume exchanges take place between these two compartments, during normal daily activities. A variety of pathological processes can alter CSF hydrodynamics, leading to the development of several conditions. These include Chiari malformations and syringomyelia, as well as extra-axial collections of CSF. They are best regarded as disorders of CSF circulation, rather than as isolated spinal pathologies.
Scoliosis and spinal deformity
Authors: Milner Peter , Gummerson Nigel
Published: October 2019

Spinal deformity is very common in the ageing population and also fairly common in the paediatric population. An understanding of the normal spinal profile in growth and ageing is essential for the successful treatment of all spinal pathology. This chapter describes the normal spine and the clinical and radiographic assessment of spinal shape. We also discuss the classification and treatment of scoliosis and kyphosis in children and adults. Spinal deformity surgery is a major undertaking and carries significant risks. These risks can be managed and reduced with a systematic approach to the care of these patients which this chapter explores.
Entrapment syndromes
Authors: Bourke Grainne , Syed Mobin
Published: October 2019

Peripheral nerve entrapment is common. Patients present with tingling and pain in the distribution of the affected nerve. This will progress to altered sensation and weakness with prolonged and/or increasing pressure. The most common nerve entrapment syndromes are carpal tunnel affecting the median nerve at the wrist and cubital tunnel affecting the ulnar nerve at the elbow. They affect the working population, so time-efficient diagnosis and robust effective treatment strategies are important to minimize the financial implications to industry. Aetiology, diagnosis, and management strategies for carpal tunnel, cubital tunnel, and meralgia paraesthetica are discussed in this chapter along with a brief overview of other entrapment syndromes. Current controversies between open and endoscopic carpal tunnel release are also reviewed.
Supraclavicular brachial plexus and peripheral nerve injuries
Authors: Perera Jonathan R , Sinisi Marco
Published: October 2019

Stretching of more than 12% of a nerve or more than 8 hours of ischaemia will result in severe nerve injury. The force required to avulse cervical nerve roots is as little as 200 newtons. The nerve root exiting angles are very important, as different forequarter positions at the time of impact will result in differing force vectors and therefore differing injury. Nerve injuries can be extremely devastating not only for the patient but for their surrounding support structure as well. We discuss and detail the diagnosis and management of these lesions along with the useful investigations and treatment options. The appropriately timed management of these patients can allow good outcomes for both patient physical and subsequent mental health.
Peripheral nerve tumours
Authors: Trivedi Ricin , Nga Vincent
Published: October 2019

This chapter on peripheral nerve sheath tumours (PNSTs) explores the pathology, clinical presentation, investigation, management, and outcomes of both benign and malignant peripheral nerve sheath tumours (MPNSTs). The focus is centred upon the more commonly encountered tumours: schwannoma, neurofibroma, and perineurioma. Significant emphasis is also given to the rarer but life-threatening MPNSTs. It aims to equip the reader with the latest information available in the literature with regards to PNSTs occurring sporadically or in association with inherited conditions. Up to date investigation and management options available are also presented. With the detailed insights provided, the aim is to ensure that the reader would be confident in managing patients presenting with peripheral nerve tumours.
Principles of deep brain stimulation
Authors: Pereira Erlick A.C , Green Alexander L , Aziz Tipu Z
Published: October 2019

Deep brain stimulation (DBS) is a minimally invasive targeted neurosurgical intervention that enables structures deep in the brain to be stimulated electrically by an implanted pacemaker. It has become the treatment of choice in Parkinson’s disease patients with either disabling medication side effects, on-off fluctuations, or tremor. Its efficacy in Parkinson’s disease has been demonstrated robustly by randomized controlled clinical trials, with numerous brain areas having been targeted in the last two decades for indications including dystonia and tremor in movement disorders; depression, obsessive-compulsive disorder, and Tourette’s syndrome in psychiatry; epilepsy, cluster headache, and chronic pain. The principles of framed stereotactic surgery enabling DBS electrode placement are reviewed here, before describing the putative mechanisms underlying DBS and its action upon individual neurons. Recent and future developments in DBS technology such as segmented, directional leads, and smart, adaptive stimulation are then discussed alongside related technological advances such as diffusion tensor imaging, robotic surgery, and molecular and cellular therapies. The role of stereotactic lesions in the era of DBS and the different modalities of lesioning are then summarized.
Cranial nerve vascular compression syndromes
Authors: Sindou Marc , Georgoulis George
Published: October 2019

Hyperactive cranial nerve syndromes originate in a large number of cases from chronic neurovascular conflict. Classical trigeminal neuralgia is the most frequent syndrome, followed by primary hemifacial spasm. Vago-glossopharyngeal neuralgia is rare, but still underestimated. Vascular compression of the vestibulocochlear nerve may be at the origin of tinnitus and positional disabling vertigo. Vascular compression of the ventrolateral medulla can be a possible cause of neurogenic essential blood hypertension. Chronic pulsatile neurovascular compression would generate ectopic stimuli that are transmitted to neighbouring fibres through focal zones of demyelination, which provokes an ephaptic mechanism between fibres. Also, chronic pulsatile compression would induce hyperactivity of the corresponding cranial nerve nuclei. In trigeminal neuralgia this hyperactivity is expressed by epileptic-like clinical manifestations that respond to anticonvulsants. MRI imaging with high-resolution protocol, and the three following sequences—3D T2 high-resolution, TOF MR-angiography, and T1 with gadolinium—permit to depict the neurovascular conflict and predict the degree of compression. First option of the treatment is microvascular decompression.
Epilepsy—diagnosis and assessment
Authors: Selway Richard
Published: October 2019

This chapter explains the incidence, classification, and diagnosis of the common epileptic syndromes. There is particular emphasis on medical management including the emergency management of status epilepticus. For much of the nineteenth century, disorders of mood, behaviour, or personality were often labelled as epileptic in nature.

More recently, there has been an acknowledgement of the socioeconomic burden of the condition, a recognition that it still carries a significant social stigma. Furthermore, as our understanding of neural networks has improved, novel techniques of neuromodulation have been developed as an adjunct to more traditional medical and resective therapeutic measures. The assessment of patients and the tests used to workup a patient prior to epilepsy surgery are also discussed in detail in this chapter, including an explanation of the invasive electroencephalography (EEG) techniques that may be used in complex cases.
Craniofaciosynostosis
Authors: Di Rocco Federico , Beuriat Pierre-Aurelien , Arnaud Eric
Published: October 2019

Craniosynostosis is a condition in which there is a premature fusion of one or more sutures of the skull with a modification of cranial growth and an abnormal skull shape. The shape is specific to the suture involved so the diagnosis is essentially clinical. The genetic causes remain largely unknown. Molecular researches have identified several mutations. Complications can result to the deformation of the skull but also abnormal facial morphology. Cerebellar tonsillar prolapse, hydrocephalus, intracranial hypertension, insufficient eye protection, respiratory obstructions, and orthodontic problems are the most common. Several factors play a role in the surgical indications. The aim of the surgery is functional and cosmetic. Techniques have evolved from simple strip to total calvarial and supraorbital remodelling, osteogenic bone distraction, and endoscopic procedures. In all craniosynostosis, long-term follow-up is mandatory because there is a risk of secondary synostosis which exists independently from the originally affected suture.
Paediatric neurovascular disorders
Authors: McCullagh Helen G , Patankar Tufail , Goddard Tony , Tyagi Atul
Published: October 2019

The spectrum of paediatric neurovascular disorders includes several conditions like arteriovenous malformation (AVM), aneurysm, and cavernous malformations that occur in adults. Despite the similarity in pathology there are differences in presentation, location, and management of vascular disorders in children as compared to adults. There are disorders that are peculiar to the paediatric population like vein of Galen malformations or intraventricular haemorrhage in premature infants and others that occur predominantly in children though are seen in adults such as moya disorder. Recent advances in endovascular therapy, radiosurgery, and multimodality management of vascular lesions have increased the options available to manage these lesions in children. Identification of underlying gene abnormalities in cavernomas and moya moya disease promises to shed new light on the pathogenesis of these disorders. The common neurovascular disorders seen in the paediatric population are discussed in this chapter with the focus on those seen predominantly in children.
Paediatric epilepsy
Authors: Varadkar Sophia , Tisdall Martin
Published: October 2019

All children, young people, and indeed adults with a recent onset suspected seizure should be seen promptly by a physician with expertise in epilepsy, to avoid misdiagnosis as well as to ensure precise and early diagnosis, and to recognize serious non-neurological diagnoses, especially cardiological ones. Paediatric epilepsy offers particular challenges in terms of diagnosis, evaluation, and management. Surgical treatment is a safe and effective management strategy in selected patients. In order to optimize seizure and cognitive outcome, surgery should be offered at an early stage in suitable, drug-resistant cases. This chapter summarizes the key steps in diagnosis, presurgical evaluation, and operative techniques required to treat this patient group and highlights the special considerations required in the paediatric population.
Normal pressure hydrocephalus
Authors: Keong Nicole
Published: October 2019

This chapter is on normal pressure hydrocephalus (NPH) and deals with aspects from theories of pathogenesis, clinical presentation, and management, surgical management, and complications, as well as the assessment of outcome. It provides a concise overview of a challenging topic; many theories have been advanced to explain the underlying mechanisms by which the NPH syndrome develops. However, the basic pathophysiological processes still remain unclear. The major theory streams proposed for the pathogenesis of NPH can be loosely organized into structural, cerebral blood flow, and cerebrospinal fluid flow subgroups. The components of each theory stream are expanded in this chapter, although the list of studies supporting each section is by no means exhaustive.
Pseudotumour cerebri syndrome
Authors: Pickard John , Higgins Nicholas
Published: October 2019

Pseudotumour cerebri syndrome, previously known as benign intracranial hypertension and more recently termed idiopathic intracranial hypertension, is characterized by headaches, raised intracranial pressure, and the risk of sudden irreversible visual loss. The pathophysiology of the condition is not fully understood but reduced cerebrospinal fluid absorption secondary to venous outflow obstruction seems to be an important factor. Treatment of patients with this condition is generally with lumbar punctures, weight loss, and lumboperitoneal shunts but ventriculoperitoneal shunts, subtemporal decompression, venous sinus stenting, and acetazolamide may also be used. Prognosis in pseudotumour cerebri syndrome is variable—some patients stabilize after a single lumbar puncture, while others have persistent symptoms for many years. A patient’s symptoms may improve and then recur years later, especially if weight has been lost and then regained again.
Microbiology
Authors: Hall Walter A.
Published: October 2019

Infection of the central nervous system can be due to a variety of pathogenic agents that include bacteria, viruses, fungi, and parasites. Several sensitive and specific diagnostic tests are now available that allow for the rapid and accurate identification of the offending organism. The widespread indiscriminate use of some antibiotics has resulted in the emergence of organisms that are resistant to those agents at an alarming rate. The prevention of a neurosurgical site infection is usually possible with the use of prophylactic antibiotics and through careful attention to surgical technique. Controversy surrounds several issues in neurosurgical practice such as preoperative surgical site preparation, antimicrobial prophylaxis, and the surgical and medical management of postoperative infections. Only after the causative microbe is determined and the appropriate surgical and medical management is initiated can you hope to achieve the optimal clinical outcome leading to a reduction in neurological morbidity and mortality.
Suicide Prevention
Authors: Kapur Navneet , Goldney Robert D.
Published: October 2019

Suicide is a major public health and mental health challenge and claims as many as one million lives worldwide each year. It is also an individual tragedy with devastating consequences for family members, friends, and others who have been bereaved. Attempted suicide and suicidal behaviour are even more common. In recent years there has been an enormous amount of research and a growing realization that suicide can be prevented. There are approaches that we can use at societal and individual levels which will potentially save lives. This book provides a comprehensive but concise overview of the field of suicide prevention. It places suicide in a historical context before highlighting its complexity and possible causes. It goes on to discuss public health strategies and policy as well as psychological and pharmacological approaches to treatment and prevention. It also includes guidance for assessing people who present to services with suicidal thoughts or behaviours, along with a number of case vignettes. Suicide bereavement and technology-based approaches to intervention are discussed, and frequently asked questions on topics as diverse as enquiring about suicidal thoughts, rational suicide, and suicide terrorism are answered. This text is practical in its focus but strongly evidence-based and will be relevant to all those with an interest in preventing suicide.
Epidemiology
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

This chapter examines the global epidemiology of suicidal behaviour. Up to one million people die by suicide every year, and about three quarters of these are in low- and middle-income countries. Twenty to thirty times this number harm themselves or attempt suicide. Global rates are probably under-reported, and the iceberg model of suicidal behaviour (showing that much suicidal behaviour is ‘under the waterline’ and thus hidden) is a helpful way of conceptualizing this. In most countries, men are greatly over-represented amongst people who die by suicide. There is a current concern about men in midlife in many high-income settings. Although suicidal behaviour can vary widely in incidence, it tends to share common antecedents. However, it should be borne in mind that the results of large population-based studies do not always apply to individuals.
The role of health services and systems
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

This chapter discusses health services and systems of care and suicide prevention. Although suicide and suicidal behaviour are sometimes seen as societal problems, health services have a key role to play. The majority of those who die by suicide have a psychiatric disorder at the time of death. Many individuals have been in contact with health services prior to suicide. Primary care, general hospitals, and specialist mental health services are all important. Service-wide changes such as crisis provision, dual-diagnosis services, and serious incident reviews can contribute to suicide prevention. Focusing on safety in particular settings (e.g. inpatient care) can also be highly effective. Clinical guidelines can improve the quality of care and outcomes for patients, but implementation is key. Safer systems of care, with a number of interventions introduced simultaneously, may help to reduce suicide.
Useful links
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

With the increasing recognition of suicide as a major health and social care issue, many suicide prevention organisations have been established locally, nationally and internationally. This chapter includes a number of links to the most prominent of these, but the list is indicative rather than exhaustive. These include the International Association for Suicide Prevention, the International Academy of Suicide Research, the Samaritans, the World Health Organization, and national suicide prevention organizations from across the world.