Advances and Technical Standards in Neurosurgery, Volume 32
Advances and Technical Standards in Neurosurgery is a periodical of the European Association of Neurosurgical Societies. It is intended for postgraduate education of young neurosurgeons. Its founders have been Bernard Pertuiset, Fritz Loew and Hugo Krayenbuhl. The goal of this periodical is to acquaint the neurosurgical community with the latest achievements in neurosurgery and adjacent specialties and to present detailed description of conventional neurosurgical interventions, written by experienced clinicians.
Volume 32 is traditionally devoted to general medical and moral aspects of neurosurgery, as well as to specific problems of surgical anatomy and technique.
The first article of the section Advances has been written by M.Vinchon and P. Dhellemmes from the Lille University hospital (France). It is entitled The Transition from Child to Adult in Neurosurgery. Development of children’s neurosurgery has given rise to a problem of preserving not only biological life of small patients, but also ensuring its acceptable quality in transition from child- to adulthood. Thus, the authors analyzed catamnesis of more than 5000 small patients, 800 of whom had overlived their childhood. In was done with the purpose of estimating problems of age transformations. They studied both medical aspects (a neurological and functional status, survival) and a degree of social activity of former patients, operated for neoplasms, hydrocephalus and meningocele. Mortality in grown-ups with neoplasms and hydrocephalus was 4.6% and 1.1% respectively. Normal social activity and ability to work was watched in 35.6%, 18.7% and 11.5% of cases with tumors, hydrocephalus and meningocele respectively. It should be noted, that estimation of intellect and activity during school years with the purpose of determining possibility of future social adaptation is, as a rule, too optimistic. The majority of problems, encountered in childhood and conditioned by the above diseases, become much deeper in adulthood due to aggressive competitive environment and absence of adequate social support. The moment of transition from one age to another demands greater attention and joint efforts of neurosurgeons, treating both small and adult patients. There is a need of special research programs for studying problems of grown-up cases, operated in childhood. Despite small economic efficacy of children’s neurosurgery, its financing should be improved in the interests of the society development as a whole and cultivation of ideology of equality and social solidarity, whose importance cannot be overestimated. Summarizing the aforesaid, one should emphasize importance of this article, elucidating social rather than medical aspects of neurosurgery, which determine its place and role in modern society.
Conflicts of Interest in Medical Practice is the second article of the section, written by J. Lobo Antunes from the University of Lisbon. The author describes several groups of such conflicts, pertaining to a financial sphere, moral and ethical relations within a scientific community and attitude to difficult or risky clinical cases, which can affect a professional reputation of a physician. In the author’s opinion, the majority of conflicts of interest concerns financial relationships between a physician and commercial structures, i.e. manufactures and suppliers of medical equipment. According to the author, the main way of overcoming or preventing these conflicts is self-regulation and self-restriction of doctors under supervision of professional ethical societies.
Neurosurgical Treatment of Perineal Neuralgias by Robert R. et al. from Nantes and Bayonne (France) is devoted to perineal pain, which is a rather frequent manifestation of several independent diseases. Thus, efforts of its treatment by uncoordinated groups of specialists are often doomed to failure. A twenty-year experience of observation and treatment of such cases and results of anatomic studies of perineum innervation allowed the authors to formulate a syndrome of n. pudendus entrapment. Anatomic studies made it possible to develop methods of blocking or surgical treatment, based on strict criteria. The randomized study demonstrated efficacy of complex treatment in 2/3 of cases. A new anatomic concept permits to widen application of this type of surgery in the hope of improving treatment results.
The first article of the section Technical Standards has been written by Dutch neurosurgeons and cardiologists from Groningen and Maastricht. It is entitled Spinal Cord Stimulation for Ischemic Heart Disease and Peripheral Vascular Disease. Analgesic epidural stimulation of the spinal cord was developed and adopted a method of treatment of ischemic heart diseases and ischemia of lower extremities in Europe in the 70s and 80s respectively. It is characterized by several positive effects on cases with drug-resistant pain syndrome. As for ischemic heart disease, stimulation reduces severity of pain syndrome in angina pectoris, improves life quality, leads to no increase of mortality and disability rates and does not mask clinical manifestations of myocardial infarction. Besides a symptomatic effect, electrostimulation possesses a reliable functional effect. The latter manifests itself in better functioning of myocardium, higher capacity for work and is considered to be an alternative of aortocoronary bypass in cases with a high risk of surgical complications. Analogous analgesic and functional effects are watched in critical ischemia of lower extremities. High efficacy of this functional neurosurgical intervention proves necessity of studying fundamental mechanisms, which mediate an effect of spinal cord stimulation on the circulatory system.
Percutaneous Destructive Pain Procedures on the Upper Spinal Cord and Brain Stem in Cancer Pain: CT-Guided Techniques, Indications and Results by Y. Kapolat from the University of Ankara is a good continuation of the above article. It describes indications and technique of radio-frequency functional destructive interventions, performed in cases with uncontrolled pain syndrome due to cancer of different localization under conditions of CT-navigation. Interventions are made at various levels of conductive pathways and include chordotomy, trigeminal tractotomy and extra-lemniscus myelotomy. Use of CT-navigation results in considerable increase of analgesic intervention efficacy and marked reduction of postoperative mortality, as compared to conventional methods of targeting under conditions of X-ray control.
Surgical Anatomy of the Petrous Apex and Petroclival Region has been written by H.-D. Fournier et al. from the Universities of Marseilles and Angers (France). It describes surgical anatomy with taking into account topographic peculiarities of main lateral microsurgical approaches to the petroclival region. Topographic anatomy of the temporal bone pyramid and peripetrous structures is considered from a classical point of view and from a position of surgical approaches with a detailed step-by-step commentary on technique of preparing anatomic structures.
Carpal Tunnel Syndrome – A Comprehensive Overview by J. Haase from the University of Aalborg (Denmark) is of great importance for practical neurosurgery. It contains a detailed and systematized review of literature on problems of epidemiology, pathophysiology, diagnosis, surgical technique and describes results and complications of treatment of the carpal tunnel syndrome. Safe and effective surgery of this pathology demands great attention to history taking and examination of a patient, as well as keeping to all nuances of surgical technique.
In conclusion it should be noted, that volume 32 of Advances and Technical Standards in Neurosurgery contains rather interesting information on urgent problems of up-to-date neurosurgery, which is useful for those, studying neurosurgery and practicing it. It meets all the goals of educational literature and can be recommended for training neurosurgeons-residents.