Neurosurgery clinics of North America
-
Neurosurg. Clin. N. Am. · Apr 2011
Review Historical ArticleIdentification of neural targets for the treatment of psychiatric disorders: the role of functional neuroimaging.
Neurosurgical treatment of psychiatric disorders has been influenced by evolving neurobiological models of symptom generation. The advent of functional neuroimaging and advances in the neurosciences have revolutionized understanding of the functional neuroanatomy of psychiatric disorders. This article reviews neuroimaging studies of depression from the last 3 decades and describes an emerging neurocircuitry model of mood disorders, focusing on critical circuits of cognition and emotion, particularly those networks involved in the regulation of evaluative, expressive and experiential aspects of emotion. The relevance of this model for neurotherapeutics is discussed, as well as the role of functional neuroimaging of psychiatric disorders.
-
Molecular imaging with positron emission tomography (PET) plays an important role in the diagnosis and management of patients with brain tumors and epilepsy. The clinical uses of FDG are discussed, as well as the research applications of novel PET tracers. Where applicable, single-photon emission computed tomography (SPECT) is also discussed.
-
The main objective of treating brain metastases is to improve survival and to reduce symptom burden, preserve function, and enhance quality of life. As such, concurrent local control of existing brain metastases, prevention of future metastasis elsewhere in the brain, and control of the systemic cancer are required. ⋯ This article is devoted to the medical management of brain metastases, namely the role of medical treatments and chemotherapy. Radiation therapy and surgery are discussed in detail elsewhere; however, a brief discussion of all of these modalities is included for the sake of thoroughness.
-
Neurosurg. Clin. N. Am. · Oct 2010
ReviewExpanded endonasal approaches to middle cranial fossa and posterior fossa tumors.
Skull base lesions that involve the middle and posterior cerebral fossae have been historically managed through extensive transcranial approaches. The development of endoscopic endonasal techniques during the past decade has made possible a vast array of alternative routes to the ventral skull base, providing the ability to expose lesions in difficult-to-access regions of the cranial base in a less invasive manner. In this review, the authors detail the endoscopic surgical anatomy and the operative nuances of the expanded endoscopic endonasal approaches to tumors of the middle and posterior cranial fossae. These techniques offer excellent exposure of the targeted regions yielding optimal resections, while avoiding the morbidity associated with transcranial surgical approaches.
-
Neurosurg. Clin. N. Am. · Oct 2010
ReviewMaking the transition from microsurgery to endoscopic trans-sphenoidal pituitary neurosurgery.
This article reviews the published experience of others and introduces the authors' insights into the development of an endoscopic pituitary program. While initially challenging, this transition to endoscopic trans-sphenoidal pituitary surgery can yield rewards in the form of superior visualization and potentially more complete tumor resections. With increasing cumulative experience with the endoscopic transsphenoidal technique for pituitary surgery, the improved visualization and less steep learning curve will facilitate more widespread acceptance of endoscopic pituitary surgery as a valid alternative to the trans-septal trans-sphenoidal microscopic approach to pituitary tumors. ⋯ The collaboration between otolaryngologists and neurosurgeons is important for further developing successful endoscopic trans-sphenoidal pituitary surgery and improving care for patients. Objective evidence is needed to validate whether the improved visualization results in superior patient outcomes and reduced clinical complications, and if this technique can be reasonably taught in a controlled, supervised setting in residency training programs. Additional outcomes data are needed to evaluate long-term outcomes and define the boundaries of endoscopic trans-sphenoidal pituitary surgery.