Acta Neurochirurgica Supplementum, Supplement99
Supplement N 99 of Acta Neurochirurgica deals with achievements in the field of functional and restorative neurosurgery. It has been edited by Professor J.W. Chang (Seoul, Korea), Professor Y. Katayama and Professor T. Yamamoto (Tokyo, Japan) and contains reports, presented at the joint conference of the Neurorehabilitation Committee of the World Federation of Neurosurgical Societies (WFNS) and the 1st Congress of the International Society of Reconstructive Neurosurgery (ISRN), held in Seoul in September 2005. These works reflect a new era in collaboration of neurosurgeons with basic neuroscientists, engineers and specialists in the field of rehabilitation.
A review, devoted to rehabilitation, has been written by K.R.H. von Wild (Germany). A growing number of survivors after severe craniocerebral trauma, resulting in considerable impairment of higher cortical functions, is a major ethical and socioeconomic burden in industrialized countries. Treating sequelae of direct brain trauma, subarachnoid hemorrhage and cerebral hypoxemia demands early neurological and neurosurgical rehabilitation. Complex restorative therapy should be carried out by different specialists, headed by a neurosurgeon. If complete restoration is impossible, then the goal of functional rehabilitation is achieving an optimum state of mental, social and professional capacity. A final outcome is determined by interdisciplinary rehabilitation, which includes such most important constituents, as neuropsychological and music therapy, as well as therapy of vocational, cognitive and psychic disturbances.
The section, devoted to involuntary movement disorders, describes deep brain stimulation, which is used not only in Parkinsonís disease, but also in cluster headache, behavioral disorders, epilepsy and dystonia. The low rate of complications, the procedure reversibility and neuronavigation availability increase the therapeutic applications of deep brain stimulation. Deep brain stimulation of the thalamus (Vo/Vim) has become a popular method of controlling involuntary movements, including post-stroke movement disturbances. Motor cortex stimulation can sometimes help to control post-stroke movement disorders and motor weakness. Taira T. et al. (Japan) describe their experience of surgical management of dystonias in 200 cases. A differentiated approach to a choice of intervention in different subtypes of dystonia allows to obtain the best results in the majority of cases. Intermittent torticollis is treated effectively with selective peripheral denervation. Focal dystonia (writerís cramp) can be alleviated by ventro-oral thalamotomy. A state of cases with generalized dystonia is improved dramatically after deep brain stimulation of globus pallidus interna. In the authorsí opinion, soon there will appear a new medical trend, i.e. dystonia surgery.
Wide use of deep brain stimulation of the subthalamic nucleus for Parkinsonís disease demands more exact determination of its boundaries. Semimicroelectrode recording of multi-cell spike density (T. Kano et al., Japan) seems to be the most practical modality. Bilateral subthalamic deep brain stimulation is a prospective and safe surgical method for Parkinsonís disease, resistant to drug therapy. 18F-Fluorodeoxyglucose (FDG) PET data have demonstrated, that its effect can result from an increase of cerebral metabolism in the lateral globus pallidus, upper brain stem, dorsolateral prefrontal cortex, posterior-parietal-occipital cortex and its decrease in the orbital frontal cortex and parahyppocampus gyrus.
The section, dealing with pain, contains information on drug therapy and surgical treatment of different types of pain syndrome.
The section on epilepsy contains articles, considering different versions of treatment. Chronic deep brain stimulation of subthalamic and anterior thalamic nuclei has demonstrated relative safety of this method, used for treatment of drug-resistant focal epilepsy. Vagus nerve stimulation can become an alternative method of treatment of pediatric intractable epilepsy. Gamma Knife radiosurgery for non-hemorrhagic arteriovenous malformations allows to control epilepsy, caused by them, quite effectively. Neuronavigation ensures both safe surgical resection of cavernous adenomas, located in eloquent areas, and effective control of seizures.
M. Visocchi (Institute of Neurosurgery, Catholic University Medical School, Rome, Italy) presents experimental and clinical data on the effect of spinal cord stimulation on cerebral hemodynamics. According to them, spinal cord stimulation prevents cerebral infarction progression in cats, improves clinical symptoms in vegetative cases, suppresses headache in migraneous patients and significantly reduces ischemic brain edema in rats.
The section, describing cell transplantation, contains experimental works on migration of bone marrow stem cells in ischemic mice brain (1) and the effect of transplantation of human mesenchymal stem cells on a motor function in rats with injured brain and spinal cord (2). The information, given in these articles, makes it possible to draw a conclusion, that injuries of cerebral tissue can stimulate migration of stem cells to an injured area. Besides, therapy with stem cells can lead to more active functional restoration.
Finally it should be noted, that Supplement N 99 of Acta Neurochirurgica, elucidating urgent problems of up-to-date functional neurosurgery, is rather interesting for physicians, studying neurosurgery, practicing neurosurgeons and neurologists. It can be recommended for use in training neurosurgical residents and neurologists.