in Neurosurgery Advances and Technical Standards Volume 4 Springer -Verlag Wien New York 1977 Edited by

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2 Advances and Technical Standards in Neurosurgery Edited by H. Krayenbuhl, Zurich (Managing Editor) J. Brihaye, Bruxelles F. Loew, Homburg/Saar V. Logue, London S. Mingrino, Padova B. Pertuiset, Paris L. Symon, London H. Troupp, Helsinki M. G. Yal?argil, Zurich Volume 4 Springer -Verlag Wien New York 1977

3 With 66 partly coloured Figures This work Is subject to copyright All rights nre reserved, whether the whole or part of the material is coneemed, specifically those of translation, reprinting, re-use of Ulustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks 1977 by Springer-Verlag/Wien Softcover reprint of the hardcover 1st edition 1977 Library of Congre.. Catalog Card Number ISBN -13: DOl: / e-isbn-13:

4 Preface There are two important reasons for publishing this new series entitled "Advances and Technical Standards in Neurosurgery": 1. the lack of anyorganized common European postgraduate training system for young neurosurgeons and 2. the language barriers, which impede the exchange of neurosurgical findings in Europe more than in other parts of the world. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore the Editors have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume. In the second part of each volume, we publish detailed descriptions of standard operative procedures, furnished by experienced clinicians; in these articles the authors describe the techniques they employ and explain the advantages, difficulties and risks involved in the various procedures. This part is intended primarily to assist young neurosurgeons in their postgraduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons. The descriptions of standard operative procedures are a novel feature of our series, and in this it differs from the similarly entitled series "Progress in Neurological Surgery"; also, our series will be mainly, but not exclusively, a forum for European neurosurgeons. We intend as well to make available the findings of European neurosurgeons which are published in less familiar languages to neurosurgeons beyond the boundaries of the authors' countries and of Europe, and we aim to promote contacts among European neurosurgeons. The Editors do hope that neurosurgeons throughout the world, and not only in Europe, will profit by the new series "Advances and Technical Standards in Neurosurgery". The Ediwrs

5 Contents A. Advances Clinical Relevance of Cerebral Blood Flow Measurements. By N. A. LAS SEN and D. H. INGVAR, Department of Clinical Physiology, Bispebjerg Hos pital, Copenhagen, Denmark, and Department of Clinical Neurophysiology, University Hospital, Lund, Sweden... 3 Introduction... 3 I. Carotid Surgery and Other Forms of Surgical Intervention on Brain Arteries... 4 II. Focal Cortical Epilepsy III. Severe Brain Damage Discussion 11 Conclusion 12 References 12 Extra-Cranial Surgery for Cerebrovascular Disease. By G. W. TAYLOR and J. S. P. LUMLEY, Surgical Professorial Unit, St. Bartholomew's Hos- pital, London, Great Britain Development of Surgery for Strokes Mechanism of the TIA Aetiology of the Stroke Syndrome Clinical Features of the Stroke Syndrome Symptoms a) Carotid Disease b) Vertebro-Basilar Disease Physical Signs Investigation Natural History of the Atherosclerotic Lesion Selection of Patients for Surgery Surgical Treatment Anaesthesia Carotid Endarterectomy Aneurysms of the Extra-Cranial CarotId Artery Acute Carotid Injuries Vertebral Arteries and Aortic Arch Results Conclusion 35 References 36

6 VIII Contents Intrathecal Injection of a Neurolytic Solution for the Relief of Intractable Pain. By J. RETIF, Department of Neurosurgery, University of Brussels, Belgium I. Introduction II. Subarachnoid Injection of Alcohol Technique ResuU.s Complications III. Subarachnoid Injection of Phenol Technique Rationale of the Method Clinical Results Complications Meningeal Irritation Vascular Hypotension Sphinct.er Disturbances, Paresis of the Extremities IV. Conclusion References B. Technical Standards Olfactory Groove and Suprasellar Menin~iomas. By L. SYMON, The Department of Neurosurgical Studies, Institute of Neurology, The National Hospital, London, Great Britain Introduction The Presenting Features of Meningiomas of the Olfactory Groove and Jugum Sphenoidale Clinical Examination Investigations Plain X-Ray EM! Scan Electro-Encephalography Gamma Scan Angiography Air Encephalography or Ventriculography Pre-Operative Management Anaesthesia Positioning the Patient Planning the Flap The Technique of Excision of Olfactory Groove Meningiomas Uncapping the Tumour Removal of the Centre of the Mass The Entering Blood Supply Definition of the Anterior Cerebral Circulation The Dissection of Optic Nerves and Chiasm Handling the Ethmoidal Vascular Supply and the Hyperostosis

7 Contents IX The Technique of Excision of Meningiomas of the Jugum Sphenoidale Control of ICP Preliminary Orientation Gutting the Tumour Identification of the Chiasmal Anatomy The Treatment of the Dural Attachment Closure Closure of Bifrontal Craniotomy for Large Orbito-Frontal Meningiomas References Microsurgical Approach to Acoustic Neurinolllas. By M. G. Y~IL, R. D. SMITH, and J. C. GASSER, Neurosurgical Clinic, University of Zurich, Switzerland I. Introduction II. Microtechnique III. Surgical Anatomy of the Cerebellopontine Angle Subarachnoid Cisterns a) Cerebellopontine Cistern b) Lateral Cerebellomedullary Cistern c) Prepontine Cistern d) Quadrigeminal Cistern e) Ambient Cistern Relationship of the Tumor to the Cistern IV. Operative Technique Position on the Operating Table Positioning the Patient Incision and Craniotomy Opening of the Dura Evaluation of the Tumor Mobilization of the Tumor Exploration of the Meatal Portion of the Tumor Closure V. Results of Microsurgical Operations on Acoustic Neurinoma Function of the Facial Nerve Function of the Cochlear Nerve Complications a) Hematoma b) Thrombosis of the Posterior Inferior Cerebellar Artery c) Infection d) Disturbances in Cerebrospinal Fluid Circulation e) Cerebrospinal Fluid Rhinorrhea... " 125 f) Tinnitus VI. Bilateral Acoustic Neurinoma VII. Anesthesia 126 VIII. Conclusion 127 References

8 x Contents Balloon Arterial Catheter Techniques in the Treatment of Arterial Intracranial Diseases. By G. DEBRUN, P. LACOUR, and J. P. CARON, University Hospital Henri Mondor, Department of Neuro.Radiology and Neuro Surgery, Creteil, France Making the Latex Sleeve Making the Balloon Introducing the Catheters into the Carotid Artery Indications Treatment of a Carotid-Cavernous Fistula Final Release of the Balloon Conclusion Summary References Author Index Subject Index

9 List of Contributors Caron, Prof. J. P., Chef du Service de Neurochirurgie, Hopital Universitaire Henri Mondor, 51, Av. du Marechal de Lattre-de-Tassigny, F Creteil, France. Debrun, Prof. Dr. G., Chef du Departement de Neuro-Radiologie, Hopital Universitaire Henri Mondor, 51, Av. du Marechal de Lattre-de-Tassigny, F Creteil, France. Gasser, Dr. J. C., Institut fiir Anasthesiologie, Kantonsspital Zurich, RamistraJ3e 100, CH-8091 ZUrich, Switzerland. Ingvar, Prof. Dr. D. H., Department of Neurophysiology, Clinic of the University, Hospital Lund, S Lund, Sweden. Lacour, Dr. P., Chef de Clinique Assistant, Service de Neuro-Radiologie, Hopital Universitaire Henri Mondor, 51, Av. du Marechal de Lattre-de-Tassigny, F Creteil, France. Lassen, Prof. Dr. N. A., Department of Clinical Physiology, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 K0benhavn NY, Denmark. Lumley, J. S. P., F. R. C. S., Surgical Professorial Unit, St. Bartholomew's Hospital, London EC 1, Great Britain. Retif, Dr. J., Clinique Neurochirurgicale, UniversiM Libre de Bruxelles, Rue Heger Bordet, 1, B-tOOO Bruxelles, Belgium. Smith, R. D., M.D., Barrow Neurological Institute, 350 West Thomas Road, Phoenix, AZ 85013, U.S.A. Symon, L., T. D., F.R.C.S., Consultant Neurosurgeon, Gough Cooper Department of Neurological Surgery, The National Hospital, Queen Square, London WC 1N 3BG, Great. Britain. Taylor, Prof. Dr. G. W., Surgical Professorial Unit, St. Bartholomew's Hospital, London EC 1, Great Britain. Y.rgil, Prof. Dr. M. G., Neurochirurgische Universitatsklinik, Kantonsspital ZUrich. RamistraJ3e too, CH-8091 ZUrich, Switzerland.