Essentials of Neurosurgical Procedures and Operations > Neurosugery

Foreword

One of the most important aspects of medical care is making the correct treatment decision. In neurosurgery, making the right decision is likewise highly important. In the late 20th century, the major question in neurosurgery was how to treat the brain without inflicting damage. Because non-invasive treatments are less likely to cause damage, they were introduced into neurosurgical practice and are being widely used today. This means that in neurosurgery “quality of life” is regarded as being just as important as, if
not more important than, just “saving a life.” This philosophy is evident through the increasing number of newly designed neurosurgical techniques, such as ovascular treatment, radiosurgery, and non-invasive functional surgical techniques. You may wonder whether these new approaches can completely replace conventional neurosurgery. At one time, we thought that conventional surgery might become obsolete. However, although new non-invasive treatments are being developed everyday, conventional surgery is still considered one of the major treatment options in neurosurgery. Currently, most neurosurgeons undergo training in both conventional surgery and non-invasive treatment approaches. This newly published book, “Essentials of Neurosurgical Procedures and Operations” deals with both basic surgery as well as non-invasive procedures in neurosurgery. It briefly and accurately explains the essential and practical aspects that are necessary in every field of neurosurgery. Moreover, this textbook is easy to understand because of the illustrations provided and because experts in each field discuss the key points of surgical operations. The Korean Neurosurgical Society (KNS) was established in 1961 after the confusing and stressful stages of war were overcome. In the ning, KNS went through a series of trials and
errors. However, we have become a leading medical nation in the world today with a lot of help and support from more medically advanced countries and medical pioneers. We have now reached such a global
level that we can share our knowledge and techniques with others in the field of neurosurgery.
The purpose of this book is to share medical techniques and beneficial information that we have gained through our own work and the work of others. For a young surgeon, the most important thing is to minimize
the learning curve when performing surgery or a medical procedure. This book is written based on the experiences of others, and offers useful content that will guide you into becoming a neurosurgery expert. In addition, the book will be a great asset to those who are in training, and those who have just started studying neurosurgery. I sincerely appreciate Professor Bum-Tae Kim who is the publication committee chair at KNS for continuous support and passion throughout the whole publication process,
and I also truly thank contributing authors and professional staff for their hard work in making this book a great success. I hope this book will lead all its readers to an awesome future.

Yong-Gu Chung, M.D., Ph.D.
15th President of Korean Neurosurgical Society
Young-Jin Lim, M.D., Ph.D.
16th President of Korean Neurosurgical Society

Foreword
One of the principle missions of the World Federation of Neurosurgical Societies is to enhance the education of the next generation of neurosurgeons all over the world. To have an appropriate and up-to-date
textbook which can be used to train neurosurgical residents is of prime importance. The Korean Neurosurgical Society is one of the largest and most active neurosurgical societies in the world. Korea has a very high standard of neurosurgical practice, and its neurosurgeons have made many important contributions to the research and practice of neurosurgery.
In 2013 the Korean Neurosurgical Society hosted the XV World Congress of Neurosurgery. This was a most significant and successful event which helped to elevate neurosurgical practice on a global scale.
Two and a half years ago the Korean Neurosurgical Society decided to publish a textbook which would focus on items related to the fundamental and essential procedures and operations in neurosurgical practice. This text book has now been completed and has admirably succeeded in fulfilling its mission. It not only includes a wealth of information which can be used in training neurosurgical residents, but accompanies the articles in the book with exceptionally clear illustrations and s. Furthermore, instead of writing the book in Korean, the editors decided to have this book written in English. As a result this book can be, and will be, shared with the world-wide community of neurosurgery. This is a very significant
contribution to the enhancement of neurosurgical training around the globe.
Congratulations to Professor Bum-Tae Kim, the Chair of the KNS Publication Committee, who served as the Editor-in-Chief of this book, and congratulations also to the President and leaders of the Korean Neurosurgical Society who had the vision to publish this very important book. The World Federation of Neurosurgical Societies supports the training of young neurosurgeons in many parts of the developing world. This textbook will be very helpful in fulfilling this mission. I believe that the publication of this book will have a profound impact on the education of young neurosurgeons around the world. The Korean Neurosurgical Society deserves great appreciation and gratitude for this outstanding contribution.

Yong-Kwang Tu, M.D., Ph.D.
President, World Federation of Neurosurgical Societies
Professor Emeritus, National Taiwan University, Taipei, Taiwan

Preface

We are publishing this textbook about the procedures and surgeries performed in a neurosurgery department for educational purposes to assist young neurosurgeons and residents undergoing training in neurosurgery at home and abroad. The topics covered in this textbook include both critical procedures and fundamental surgeries performed in neurosurgery. They include the less-invasive procedures as well as highly complex surgical operations that can increase competitiveness in neurosurgery. New topics are introduced as well that have not yet found their way into neurosurgery practice. The 36 chapters in this book include discussions of 3 basic procedures, 21 cranial procedures and operations, and 12 spinal and
peripheral procedures and operations. The material is presented based on the principal that we adhere to the basics, even if the level of difficulty differs from one procedure to another. The authors include professors actively conducting research in their neurosurgery specialty at a university hospital.
Each author wrote 2 chapters, but if necessary, another author was recommed by the coauthors to contribute to a particular chapter. In all, 35 young, ambitious authors participated in writing the 36 chapters.
To illustrate and support the concepts presented in each chapter, medical drawings and illustrations are included. Tables and call-out boxes are also used to provide emphasis where needed. All illustrations were produced by a professional medical illustrator, and each author reviewed the illustrations and suggested modifications, which were then made. To maintain objectivity and to correct manu errors, we had regular editorial meetings. After all the writing and editing was completed, we had a professional language agency in the United States review the book to correct any English language errors. However, because this is the first English textbook issued by the Korean Neurosurgical Society, there will likely be some points that will be missing, and we believe, therefore, that further revision will be necessary in a future edition.
We hope that this book provides educational guidelines for young neurosurgeons in Korea as well as those all over the world, especially in developing countries, and we expect that this textbook will contribute
to the next level of advanced neurosurgical treatment and surgery.
Finally, I am sincerely grateful to all the authors who have written articles and participated in the compilation of this book over the last two and one-half years. Also, I thank Medical Illustrator Dong-Su Jang who directed the medical illustration work and Sun-hee Shin, publisher Panmun Books, for their dedication.

Bum-Tae Kim, M.D, Ph.D.
Publication committee chair of Korean Neurosurgical Society
v

Foreword iii
Preface v
Contributing Authors vii

Basic procedures Part I

 

Chapter 1 Tracheostomy 3

Definition 3

Anatomy (muscles around trachea) 3

Indications 3

Operative techniques  3

Complications 8

References8

 

Chapter 2  Central venous catheterization 9

Definition and type 9

Anatomy9

Indications 10

Contraindications 10

Central venous catheterization by using seldinger techniques 11

Complications 15

References 15

 

Chapter 3  Principles of transfemoral catheter cerebral angiography 17

Introduction 17

Anatomy17

Common usage of transfemoral catheter cerebral angiography 18

Pre-procedural evaluation and medication 18

Preparation for the procedure 18

Operative techniques 19

Post-procedural remarks  20

Complications 21

Summary and conclusions 21

References 22

 

Cranial procedures & operations Part II

 

Chapter 4  Anesthesia and surgical position 25

Neuroanesthesia 25

Introduction 25

Anesthetic agents 25

Monitoring in neuroanesthesia 27

Positioning 27

Pediatric neuroanesthesia 27

Anesthesia for posterior fossa surgery 27

Anesthesia for aneurysm surgery 27

Anesthesia for cervical spine surgery 27

Anesthesia for awake craniotomy 28

Surgical position 28

References 31

 

Chapter 5  Ventriculostomy 33

External ventricular drain or extraventricular drain 33

Introduction 33

Indications  33

Surgical techniques 33

Puncture site 34

Management of the EVD 34

Complications 34

Ventriculoperitoneal shunt 35

Introduction  35

Indications  35

Contraindications  35

Surgical techniques 35

Complications 36

References 37

 

Chapter 6  Chronic subdural hematoma 39

Introduction 39

Treatments 39

Operative techniques 39

Complications 41

References 41

 

Chapter 7 Acute epidural hematoma 43

Introduction 43

Indications for surgery 43

Timing of surgery 43

Operative techniques: a standard frontotemporal craniotomy 43

Complications 46

References 46

 

Chapter 8 Acute subdural hematoma 47

Introduction 47

Indications for surgery 47

Operative techniques 47

Complications 49

References 49

 

Chapter 9 Navigation guided hematoma removal 51

Introduction 51

Indications of navigation assisted brain surgery51

Preoperative evaluation 51

Operative techniques 51

Post operative complications 54

References 54

 

Chapter 10 Pterional approach 55

Introduction 55

Anatomy55

Indications 55

Operative techniques 55

Complications 58

References 59

 

Chapter 11 Subfrontal approach 61

Introduction 61

Anatomy61

Indications  61

Preop evaluation  62

Operative techniques 62

Post operative complications 65

References 65

 

Chapter 12 Orbitozygomatic approach 67

Introduction 67

Indications  67

Operative techniques 67

Complications 70

References 70

 

Chapter 13 Anterior interhemispheric approach 71

Introduction 71

Anatomy71

Indications 71

Preop evaluation 71

Preparation for the operation 71

Operative techniques  71

Complications 74

References 75

 

Chapter 14 Transsphenoidal approach 77

Introduction 77

Indications and contraindications 77

Pre-operative evaluation 77

Preparation for the procedure 77

Operative techniques 78

Complications 80

References 81

 

Chapter 15 Transventricular approach 83

Introduction 83

Anatomy83

Approaches to the lateral ventricle 83

Approaches to the third ventricle 85

Approaches to the fourth ventricle 88

References 88

 

Chapter 16 Endoscopic third ventriculostomy 89

Indications 89

Preoperative risk factors 89

Preoperative management and evaluation 89

Operative techniques 89

Complications91

Postoperative remarks91

References91                           

 

Chapter 17 Anterior temporal lobectomy and amygdalohippocampectomy 93

Indication 93

Key anatomy of medial temporal lobe  93

Preoperative evaluation 94

Operative techniques 95

Complications 97

References 98

 

Chapter 18 Subtemporal approach 99

Introduction 99

Anatomy99

Indications  99

Preoperative evaluation and preparation 99

Operative techniques: Standard subtemporal approach100

Subtemporal transtentorial approach101

Complications102

References102

Chapter 19 Suboccipital retrosigmoid approach 105

Introduction105

Anatomy105

Indications107

Preparations for surgical procedure107

Operative techniques107

Complications110

References110

 

Chapter 20 Midline suboccipital approach 111

Introduction111

Anatomy111

Indications112

Preparations for surgical procedure112

Operative techniques112

Complications113

References114

 

Chapter 21 Carotid arterectomy 115

Introduction115

Indications and contraindications115

Anatomy116

Operative techniques 116

Complications119

References119

 

Chapter 22

Superficial temporal artery (STA) - middle cerebral artery (MCA) bypass 121

Indications121

Pre- and post-operative medical management121

Intra-operative management121

Operative techniques121

Post-operative complications125

References125

 

Chapter 23 Balloon angioplasty and carotid artery stenting (CAS) 127

Introduction127

Indications127

Preparation128

Pre-procedure 129

Procedures130

Assessment of post-stenting131

Further dilation131

Medical therapy of complications131

Post-procedural care131

Follow up132

Retreatment 132

References132

 

Chapter 24 Basic ovascular techniques: Coil embolization of aneurysms 133

Introduction133

Preparation for procedure133

Set up136

Operative techniques136

Simple technique136

Balloon remodeling technique (wide-necked aneurysm)138

Stent-assisted technique140

References140

Spinal and peripheral procedures & operations Part III

 

Chapter 25 Facet block and medial branch block 145

Introduction145

Anatomy145

Indications146

Contraindications146

Preparation for the procedure 146

Operative techniques146

Complications148

Summary148

References148

 

Chapter 26 Spinal tapping and epidural block 151

Spinal tapping 151

Introduction151

Anatomy151

Indications151

Contraindications151

Preparation for the procedure 151

Operative techniques151

Normal cerebrospinal fluid152

Complications152

Summary152

Epidural Block 152

Introduction152

Anatomy152

Indications153

Contraindications153

Preparation for the procedure 153

Operative techniques154

Complications156

Summary and conclusion156

References156

 

Chapter 27 Root block 157

Cervical nerve root block 157

Definition157

Indications 157

Contraindications157

Preparation for the procedure157

Operative techniques157

Complications158

Lumbar and sacral nerve root block 158

Definition158

Anatomy 158

Indications159

Contraindications159

Preparation for the procedure159

Operative techniques159

Complications160

Postoperative remarks (cervical & lumbosacral root block) 160

References161

 

Chapter 28 Vertebroplasty and kyphoplasty 163

Introduction163

Anatomy163

Indications163

Contraindications163

Preparation for the procedure 163

Operative techniques164

Complications166

Summary166

References166

 

Chapter 29 Open carpal tunnel release 169

Introduction 169

Anatomy169

Indications 170

Preoperative evaluation 170

Preparation for the procedure170

Operative techniques171

Complications171

References171

 

Chapter 30 Cervical laminoplasty 173

Introduction173

Anatomy173

Indications173

Relative contraindications173

Preoperative evaluation174

Preparation for the procedures174

Operative techniques174

Postop remarks175

Complications176

Summary176

References176

 

Chapter 31

Anterior cervical discectomy and cervical corpectomy with reconstruction 179

Introduction179

Anatomy179

Indications180

Preparation for the procedure180

Operative techniques181

Complications185

Summary185

References186

 

Chapter 32 Posterior cervical fusion 187

Introduction187

Anatomy187

Indications188

Preoperative evaluation188

Operative techniques188

Postoperative remarks192

Complications192

References192

 

Chapter 33 Lumbar microdisectomy 193

Introduction193

Indications193

Operative techniques193

Postoperative remarks196

Complications196

References196

Chapter 34 Posterior lumbar interbody fusion 199

Introduction199

Indications199

Operative techniques199

Complications202

References202

 

Chapter 35 Minimally invasive transforaminal lumbar interbody fusion 203

Introduction203

Indications204

Operative techniques204

Complications206

References206

 

Chapter 36 Transpleural or extrepleural retroperitoneal approach 209

Introduction209

Anatomy209

Indications 210

Preparation for the procedure 211

Operative techniques211

Complications215

Summary215

References 216

Index 217