Eso Masterclass In Neuro-Oncology: Multidisciplinary Management Of Adult Brain Tumour

September 20 — September 22

Milan, Italy

Programme

The European School of Oncology was founded by Umberto Veronesi and Laudomia Del Drago in 1982, with the aim of contributing to the reduction of deaths from cancer due to late diagnosis and/or inadequate treatment. By improving the skills of all health professionals dealing with cancer patients, ESO helps shorten the time needed to transfer knowledge from research centres to daily practice, combining advanced technology with humanism in care.

ESO’s mission is reflected in its motto “Learning to Care”, which emphasises the importance of the learning process, and the goal of caring for the patient in a holistic sense, in contrast to focusing purely on treating the disease.

Due to its financial independence, ESO has the rare privilege of being able to set its own priorities. It therefore pays particular attention to developing the transfer of knowledge in areas that are least supported by industry, such as surgery and in rare pathologies (including childhood tumours), and in countries and regions with limited economic resources.

Intracranial Epidural Bleeding: History, Management, and Pathophysiology

Intracranial Epidural Bleeding: History, Management, and Pathophysiology

by Jeremy Christopher Ganz (Author)

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Intracranial Epidural Bleeding: History, Management, and Pathophysiology examines the history of the concepts underlying the understanding of the clinical features of epidural bleeding. The pathophysiology of epidural bleeding was examined in two PhD theses in the 1980s, with the results published in top international journals. However, these concepts have not been understood by the general neurosurgical community. This book provides a comprehensive overview of how epidural bleeding actually works. It can be used to help improve the interpretation of images during management, and to assess degrees of urgency. This book is written for neurosurgeons, neurologists, cerebrovascular physiologists, trauma surgeons, and medical historians.

  • Focuses on the understanding of the clinical features of epidural bleeding
  • Helps to improve the interpretation of images during management, and in assessing degrees of urgency
  • Includes a comprehensive historical review of the understanding of epidural bleeding over time

see Intracranial acute epidural hematoma.

Arachnoid Cysts: Clinical and Surgical Management

Arachnoid Cysts: Clinical and Surgical Management

Nov 3, 2017

by Knut Wester


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Arachnoid Cysts: Clinical and Surgical Management gives a broad and updated presentation of the condition, including symptomatology, diagnostics, management and treatment. The book covers the effects of surgical treatment on clinical symptoms and the effects cysts have on cognition, as well as cognitive improvement after surgical cyst decompression. This book is written for researchers, residents and clinical practitioners in clinical neuroscience, neurology, neurosurgery, neuroradiology and pediatrics.

  • Covers the symptomology and treatment of arachnoid cysts
  • Describes impaired cognition associated with arachnoid cysts
  • Identifies the advantages, disadvantages and results of different surgical approaches
  • Provides valuable information to researchers, residents and clinical practitioners in clinical neuroscience, neurology, neurosurgery, neuroradiology and pediatrics

Transsphenoidal Surgery: Complication Avoidance and Management Techniques

Transsphenoidal Surgery: Complication Avoidance and Management Techniques

Transsphenoidal Surgery: Complication Avoidance and Management Techniques
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This work details contemporary clinical knowledge on the multidisciplinary management of pituitary and other sellar/parasellar tumors, with a focus on surgical techniques and a particular emphasis on complication avoidance and management. International experts provide guidance on natural history, radiologic and clinical aspects, surgical indications, and resection techniques.In addition, case presentations and clinical photographs help the reader reduce the risk of error and advance their own surgical skills. Readers also have access online to streaming videos of key procedures to help them provide the best possible outcomes for every patient.

Transsphenoidal Surgery: Complication Avoidance and Management Techniques will be of great value to Neurosurgeons, Otolaryngologists, Endocrinologists, Radiation Oncologists, and residents and fellows in these specialties.

Product Details

  • Published on: 2017-06-13
  • Original language: English
  • Number of items: 1
  • Dimensions: 9.30″ h x .0″ w x 6.10″ l,
  • Binding: Hardcover
  • 641 pages

Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition

The scope and purpose of the Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. is 2-fold: to synthesize the available evidence and to translate it into recommendations. This document provides recommendations only when there is evidence to support them. As such, they do not constitute a complete protocol for clinical use.
The intention is that these recommendations be used by others to develop treatment protocols, which necessarily need to incorporate consensus and clinical judgment in areas where current evidence is lacking or insufficient.
Carney et al. think it is important to have evidence-based recommendations to clarify what aspects of practice currently can and cannot be supported by evidence, to encourage use of evidence-based treatments that exist, and to encourage creativity in treatment and research in areas where evidence does not exist. The communities of neurosurgery and neurointensive care have been early pioneers and supporters of evidence based medicine and plan to continue in this endeavor. The complete guideline document, which summarizes and evaluates the literature for each topic, and supplemental appendices (A-I) are available online at https://www.braintrauma.org/coma/guidelines 1).
4th edition
Free article of Neurosurgery

1) Carney N, Totten AM, OʼReilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2016 Sep 20. [Epub ahead of print] PubMed PMID: 27654000.

Book: Neurotrauma Management for the Severely Injured Polytrauma Patient

Neurotrauma Management for the Severely Injured Polytrauma Patient

Neurotrauma Management for the Severely Injured Polytrauma Patient
List Price : $129.00
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This text addresses many of the questions which occur when medical professionals of various disciplines interact and have different plans and interventions, each with its own valid scientific and/or experience-based rationale:  Questions involving tourniquet placement, ideal fluids and volumes for resuscitation, VTE prophylaxis and many other management considerations. Straightforward decisions in the patient with a single diagnosis often conflict when applied to the neurologically injured polytrauma patients.

 Neurotrauma Management for the Severely Injured Polytrauma Patient answers as many of these questions as possible based on the current literature, vast experience with severe neurotrauma in the current conflicts in Afghanistan and Iraq, and the experience of trauma experts across the globe as well as proposes areas for future study where answers are currently less clear.

Product Details

  • Published on: 2017-01-13
  • Original language: English
  • Number of items: 1
  • Dimensions: 10.00″ h x .0″ w x 7.00″ l, .0 pounds
  • Binding: Hardcover
  • 340 pages

James M. Ecklund, M.D., F.A.C.S. serves as Chairman of the Inova Neuroscience Institute. Prior to joining Inova Medical Group, he served as Professor and Chairman of the Neurosurgery Program of the National Capital Consortium, which includes Walter Reed Army Medical Center, National Naval Medical Center and the Uniformed Services University. He is a retired colonel in the U.S Army and was deployed as a Neurosurgeon to both Afghanistan and Iraq. His program received the vast majority of American neurotrauma casualties.

Dr. Ecklund’s primary clinical and research interests include complex spine, cerebrovascular disease and neurotrauma with an emphasis on blast and penetrating injury. He directs a neurotrauma laboratory at the Uniformed Services University, has over 100 publications and abstracts, and has lectured throughout the world. He also has served on multiple oversight and advisory boards for the Veterans Administration, Department of Defense, National Institutes of Health, NATO, Neurotrauma Foundation, and Brain Trauma Foundation.

Leon E. Moores, MD, MS, FACS is the CEO of Pediatric Specialists of Virginia and the Associate Chair for Pediatric Programs at the Inova Neuroscience Institute. He retired as a Colonel from the US Army where he led as an Infantry Platoon Leader, Chief of Neurosurgery at Walter Reed, Chairman of the Department of Surgery at Walter Reed, Deputy Commander of the National Naval Medical Center, and Commander of the Fort Meade Medical System. Dr Moores also served two tours of duty in Afghanistan and Iraq.
Dr Moores’ clinical and research interests center on brain and spinal tumors in children, CNS infections in combat soldiers, and complex craniofacial reconstruction in severe head and facial trauma. He is a Professor of Surgery and Pediatrics at the Uniformed Services University, and a Professor of Neurosurgery at Virginia Commonwealth University.

Management of Type II odontoid process fracture in octogenarians

As odontoid process fractures become increasingly common in the aging population, a technical understanding of treatment approaches is critical.
Establishing a clear treatment paradigm for octogenarians with odontoid fracture type II in hampered by a literature replete with level III articles.

Surgical treatment

Anterior approach

Anterior odontoid screw fixation was first reported by Nakanishi 1) and Bohler 2). This procedure provides immediate spinal stability, preserves the normal rotation between C1-2, allows the best anatomical and functional outcome for type II odontoid fracture, and is associated with rapid patient mobilization, minimal postoperative pain and a short hospital stay. Acute odontoid fractures treated by anterior screw fixation have a fusion rate of approximately 90 percent 3).

Posterior approach

Posterior approach for stabilization of odontoid fracture is indicated in the cases of odontoid fracture that are not amenable to anterior screw fixation. Commonly used procedures involve wedging a bone graft between posterior arch of C1 and the C2 lamina with sublaminar wiring. The well-described different methods for this C1- 2 posterior fusion procedure are the Gallie, Brooks, Sonntag techniques. These procedures have a satisfactory fusion rate of about 74 percent. The demerit of this procedure is that it causes elimination of the normal C1-2 rotatory motion ( which accounts for more than 50% of all cervical spine rotatory movements) and reduced cervical spine flexion– extension by 10 percent.
Another excellent alternative technique for odontoid fracture is the posterior C1-2 transarticular screw fixation (Magerl’s procedure) using unilateral or bilateral screws. This provides an excellent spinal rotational spinal stability. This is an indirect method of stabilizing the fracture (in which the normal anatomical configuration is disrupted). Preoperative CT evaluation is mandatory to avoid vertebral artery injury in this procedure. This technique can be supplemented with metal plate for occipito-cervical stabilization. Alternatively, Jain’s technique of occipitocervical fusion, Goel’s plate and screw lateral mass fixation, or a Ransford’s contoured rod technique31 may be utilized.

Case series

2017

In the study by Graffeo et al., the authors evaluated 111 patients over the age of 79 (average age: 87) with type II odontoid fractures undergoing nonoperative (94 patients) vs. operative intervention (17 total; 15 posterior and 2 anterior). They studied multiple variables and utilized several scales [abbreviated injury scale (AIS), injury severity score (ISS), and the Glasgow coma scale (GCS)] to determine the outcomes of nonoperative vs. operative management.
Graffeo et al. concluded that there were no significant differences between nonoperative and operative management for type II odontoid fractures in octogenarians. They found similar frequencies of additional cervical fractures, mechanisms of injury, GCS of 8 or under, AIS/ISS scores, and disposition to “nonhome” facilities. Furthermore, both appeared to have increased mortality rates at 1-year post injury; 13% during hospitalization, 26% within the first post-injury month, and 41% at 1 year.
In the editorial by Falavigna, his major criticism of Graffeo’s article was the marked disparity in the number of patients in the operative (17 patients) vs. the nonoperative group (94 patients), making it difficult to accept any conclusions as “significant”. He further noted that few prior studies provided level I evidence, and that most, like this one, were level III analyses that did not “significantly” advance our knowledge as to whether to treat octogenarians with type II odontoid fractures operatively vs. nonoperatively 4).


Pisapia et al., present in a stepwise fashion the technique of odontoid screw placement using the Medtronic O arm navigation system and describe their initial institutional experience with this surgical approach.
The authors retrospectively reviewed all cases of anterior odontoid screw fixation for Type II fractures at an academic medical center between 2006 and 2015. Patients were identified from a prospectively collected institutional database of patients who had suffered spine trauma. A standardized protocol for navigated odontoid screw placement was generated from the collective experience at the authors’ institution. Secondarily, the authors compared collected variables, including presenting symptoms, injury mechanism, surgical complications, blood loss, operative time, radiographically demonstrated nonunion rate, and clinical outcome at most recent follow-up, between navigated and nonnavigated cases.
Ten patients (three female; mean age 61) underwent odontoid screw placement. Most patients presented with neck pain without a neurological deficit after a fall. O-arm navigation was used in 8 patients. An acute neck hematoma and screw retraction, each requiring surgery, occurred in 2 patients in whom navigation was used. Partial vocal cord paralysis occurred after surgery in one patient in whom no navigation was used. There was no difference in blood loss or operative time with or without navigation. One patient from each group had radiographic nonunion. No patient reported a worsening of symptoms at follow-up (mean duration 9 months).
The authors provide a detailed step-by-step guide to the navigated placement of an odontoid screw. Their surgical experience suggests that O-arm-assisted odontoid screw fixation is a viable approach. Future studies will be needed to rigorously compare the accuracy and efficiency of navigated versus nonnavigated odontoid screw placement 5).

2016

Twenty-one of 22 patients who underwent posterior C1-C2 temporary fixation of an odontoid fracture achieved fracture healing and regained motion of the atlantoaxial joint. The functional outcomes of these 21 patients were compared with that of a control group, which consisted of 21 randomly enrolled cases with posterior C1-C2 fixation and fusion. The differences between the 2 groups in the visual analog scale score for neck pain, neck stiffness, Neck Disability Index, 36-Item Short Form Health Survey, and time to fracture healing were analyzed.
Significantly better outcomes were observed in the temporary-fixation group for visual analog scale score for neck pain, Neck Disability Index, and neck stiffness. The outcomes in the temporary-fixation group was superior to those in the fusion group in all dimensions of the 36-Item Short Form Health Survey. There were no significant differences in fracture healing rate and time to fracture healing between the 2 techniques.
Functional outcomes were significantly better after posterior C1-C2 temporary fixation than after fusion. Temporary fixation can be used as a salvage treatment for an odontoid fracture with an intact transverse ligament in cases of failure of, or contraindication to, anterior screw fixation 6).

2015

Data of twenty patients who underwent posterior temporary-fixation due to Anderson-D’Alonzo type II odontoid fractures with intact transverse ligament were retrospectively reviewed. Another twenty patients undergoing anterior screw fixation were randomly selected as the control group. The range of motion (ROM) in rotation of C1-C2 measured on functional computed tomography (CT) scan and outcomes evaluated by the visual analog scale (VAS) for neck pain, neck stiffness, patient satisfaction, and neck disability index (NDI) were compared between two groups at the final follow-up.
At the final follow-up, 19 cases in each groups achieved facture healing. Total C1-C2 ROM in rotation on both sides in the posterior temporary-fixation group was 32.4 ± 12.5°, smaller than 40.0 ± 13.0 in the anterior fixation group. However, there was no statistical difference between two groups. And there was no significant difference between two groups in functional outcomes evaluated by VAS for neck pain, neck stiffness, patient satisfaction and NDI.
Posterior temporary-fixation can spare the motion of C1-C2 and achieve same good clinical outcomes as anterior screw fixation in the treatment of Anderson-D’Alonzo type II odontoid fractures. It was an ideal alternative strategy to anterior screw fixation 7).


The treatment of type II odontoid fractures in elderly patients is controversial.
Anterior screw fixation is a well-recognized technique that is used to stabilize Type IIB fractures of the odontoid process in the elderly. However, advanced age and osteoporosis are 2 risk factors for pseudarthrosis. Kyphoplasty has been described in the treatment of lytic lesions in C-2. Terraux et al. decided to combine these 2 techniques in the treatment of unstable fractures of the odontoid.
Two approximately 90-year-old patients were treated for this type of fracture. Instability was demonstrated on dynamic radiography in one patient, and the fracture was seen on static radiography in the other.
Clinical parameters, pain, range of motion, 36-Item Short Form Health Survey (SF-36) score (for the first patient), and radiological examinations (CT scans and dynamic radiographs) were studied both before and after surgery. After inflating the balloon both above and below the fracture line, the authors applied a high-viscosity polymethylmethacrylate cement. Some minor leakage of cement was noted in both cases but proved to be harmless. The screws were correctly positioned. The clinical result was excellent, both in terms of pain relief and in the fact that there was no reduction in the SF-36 score. The range of motion remained the same. A follow-up CT scan obtained 1 year later in one of the patients showed no evidence of change in the materials used, and the dynamic radiographs showed no instability. This combination of kyphoplasty and anterior screw fixation of the odontoid seems to be an interesting technique in osteoporotic Type IIB fractures of the odontoid process in the elderly, with good results both clinically and radiologically 8).

1) Nakanishi T. Internal fixation of odontoid fractures. Cent J Orthop Trauma Surg 1980; 23: 399-406.
2) Bohler J. Anterior stabilization for acute fractures and nonunions of the dens.J Bone Joint Surg (Am) 1982; 64: 18-27.
3) Julien TD, Frankel B, Traynelis VC, Ryken TC. Evidence- based analysis of odontoid fracture management. Neurosurg Focus 2000; 8: 1-6.
4) Epstein NE. Commentary on the management of type II odontoid process fractures in octogenarians: Article by Graffeo et al. and Editorial by Falavigna (J Neurosurgery Spine August 19, 2016). Surg Neurol Int. 2016 Nov 21;7(Suppl 38):S901-S904. doi: 10.4103/2152-7806.194515. PubMed PMID: 28028444; PubMed Central PMCID: PMC5159695.
5) Pisapia JM, Nayak NR, Salinas RD, Macyszyn L, Lee JY, Lucas TH, Malhotra NR, Isaac Chen H, Schuster JM. Navigated odontoid screw placement using the O-arm: technical note and case series. J Neurosurg Spine. 2017 Jan;26(1):10-18. doi: 10.3171/2016.5.SPINE151412. PubMed PMID: 27517526.
6) Guo Q, Deng Y, Wang J, Wang L, Lu X, Guo X, Ni B. Comparison of Clinical Outcomes of Posterior C1-C2 Temporary Fixation Without Fusion and C1-C2 Fusion for Fresh Odontoid Fractures. Neurosurgery. 2016 Jan;78(1):77-83. doi: 10.1227/NEU.0000000000001006. PubMed PMID: 26348006.
7) Guo Q, Zhang M, Wang L, Lu X, Guo X, Ni B. Comparison of Atlantoaxial Rotation and Functional Outcomes of two Non-Fusion Techniques in the Treatment of Anderson-D’Alonzo type II Odontoid Fractures. Spine (Phila Pa 1976). 2015 Dec 10. [Epub ahead of print] PubMed PMID: 26656043.
8) Terreaux L, Loubersac T, Hamel O, Bord E, Robert R, Buffenoir K. Odontoid balloon kyphoplasty associated with screw fixation for Type II fracture in 2 elderly patients. J Neurosurg Spine. 2015 Mar;22(3):246-52. doi: 10.3171/2014.11.SPINE131013. Epub 2015 Jan 2. PubMed PMID: 25555053.
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