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Advances and Technical Standards in Neurosurgery


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A. Advances.- Is There any Future for Robots in Neurosurgery?.- I. Introduction.- II. Robotics in Medicine and Neurosurgery: History and General Principles.- II.1. History of the Robotics Concept in Medicine.- II.2. General Principles of a Neurosurgical Robotized Set-up.- A. Stereotactic Frames.- B. X-ray Systems.- III. State of the Art of Medical Robotics.- III.1. Robots in Neurosurgery.- A. Stereotactic Robots.- A.1. The K woh-Young (Long Beach) System.- A.2. The Grenoble Stereotactic Robot System.- 1. Description of the System.- 2. Data Acquisition.- a) Calibration.- b) Projective Neuroradiology.- c) CT-scan.- d) MRI.- 3. General Procedure.- 4. Clinical Applications.- a) Tumour Biopsies (141 cases).- b) Stereo-electro-encephalographic (SEEG) Investigations of Epileptic Patients (14 cases).- c) Brachytherapy (5 cases).- d) Midline Stereotactic Neurosurgery.- e) Operative Complications.- 5. Perspectives.- a) Short Term Perspectives.- b) Middle Term Perspectives.- A.3. The Lausanne System.- B. Stereotactically Guided Open-field Surgical Robots.- B.1. The Mayo Clinic System.- B.2. The Grenoble-Paris-Rennes Robotized Microscope.- C. Positioning Robots.- C.1. The "Neuronavigator".- C.2. The Retractor Robot.- III.2. Robots in Other Medical Fields.- A. Ophthalmology.- B. Robot Assisted Nursing Care.- IV. Future Applications and Science-fiction.- IV.1. Open Surgery.- IV.2 Flexible Robots.- IV.3 Sensor Guided Robots.- V. Discussion and Conclusion.- References.- Aspects of the Medical Management in Aneurysmal Subarachnoid Hemorrhage.- Prevention of Rebleeding.- I. Drug Administration.- II. Results of the Treatment.- III. Complication s of the Treatment.- IV. Conclusion.- Prevention and Treatment of Cardiac Arrhythmias.- I. Incidence.- II. Description.- III. Etiology.- IV. Prevention or Treatment.- Prevention and Treatment of Hyponatremia.- I. Signs and Symptoms.- II. Etiology.- III. Treatment.- Prevention of Seizures and Epilepsy.- I. Early Seizures.- II. Late Epilepsy.- Prevention of Cerebral Arterial Vasospasm.- I. Correction of Hypovolemia.- II. Calcium Antagonists.- A. Pharmacology.- B. Nimodipine.- 1. Uncontrolled Prospective Studies.- a) Uncontrolled Single Centre Studies.- b) Uncontrolled Multicentre Studies.- 2. Placebo-Controlled Randomized Studies.- a) Controlled Single Centre Studies.- b) Controlled Multicentre Studies.- 3. Discussion.- C. Nicardipine.- D. Other Calcium Antagonists.- 1. Diltiazem.- 2. Flunarizine.- III. Other Drugs.- A. Nizofenone.- B. Reserpine + Kanamycin.- C. Anti -Thromboxane A2 Synthetase.- D. Heparin.- E. Dipyridamole.- F. Ticlopidine.- Treatment of Symptomatic Vasospasm.- I. Hypervolemia and Hypertension.- A. Hypervolemia.- B. Hypertensive Hypervolemia.- 1. Vasopressive Drugs.- 2. Hypervolemia and Dopamine.- 3. Hypertensive Hypervolemia.- 4. Hypertension + Hypervolemia + Hemodilution.- II. Vasoactive Drugs.- A. Isoproterenol + Lidocaine.- B. Isoproterenol + Aminophylline.- C. Aminophylline + Nitroprusside + Dopamine.- D. Nimodipine.- III. Naloxone.- IV. Barbiturates.- V. Steroids.- A. Hydrocortisone in Large Doses.- B. Dexamethasone, Betamethasone, Methylprednisolone.- Conclusions.- References.- B. Technical Standards.- Unilateral Partial Hemilaminectomy for the Removal of Extra- and Intramedullary Tumours and AVMS..- Osteoplastic Laminectomy.- Unilateral (Partial) Hemilaminectomy.- Clinical Material.- Operative Technique.- Discussion.- References.- Organization of the Primary Transportation of Head Injuries and Other Emergencies in the Federal Republic of Germany.- Advancesin Drug Delivery Systems and Applications in Neurosurgery..- 1. Implantable Drug Delivery Systems.- 1.1 Access Ports.- 1.2 Implantable Pumps.- 1.2.1 Pulsatile Pumps.- 1.2.2 Continuous Flow Pumps.- 1.2.3 Programmable Pumps.- 2. Implantation Techniques.- 2.1 Catheter Placement.- 2.2 Implantation of a Drug Administration System.- 3. Current Clinical Applications.- 3.1 Intrathecal Spinal and/or Intra-cerebro-ventricular Morphine in Intractable Cancer Pain.- 3.1.1 Neurobiological Basis.- 3.1.2 Selection Criteria.- 3.1.3 Intrathecal Administration of Opiates via the Lumbar Route.- Patients.- Implantation Technique.- Results.- Side Effects of Morphine.- Discussion.- 3.1.4 Intra-(cerebral)-ventricular Morphinotherapy.- Patients.- Administration Technique and Morphine Titration.- Results.- Discussion.- 3.1.5 Conclusion - Perspectives.- 3.2 Iritrathecal Baclofen for Control of Severe Spasticity.- 3.2.1 Neurochemical and Pharmacokinetic Basis.- 3.2.2 Patient Selection Criteria.- 3.2.3 Implantation for Chronic Intrathecal Administration, Titration and Out-patient Follow-up.- 3.2.4 Clinical Results.- Administration ofa Single Intrathecal Bolus of Baclofen.- Results After Chronic Administration.- Complications.- Infections and Neurological Complications.- Pharmacological Complications.- Acquired Tolerance.- 3.2.5 Discussion.- Inter-individual Differences in Dose.- Influence of Etiology on Functional Improvement.- Pharmacological Complications and Risks.- Alternatives to Intrathecal Baclofen.- 3.2.6 Conclusion.- 4. Other Clinical Applications and Perspectives.- 4.1 Intracarotid and Direct Intratumoural Chemotherapy for Malignant Glioma.- 4.1.1 The Rationale.- 4.1.2 Local or Regional Intracarotid Chemotherapy.- 4.1.3 Direct Intra-tumoural Chemotherapy.- 4.2 Intraventricular Cholinergic Drug Infusion for Alzheimer's Disease.- 4.3 Intrathecal Infusion of TRH in Amyotrophic Lateral Sclerosis.- 4.4 Perspectives.- Conclusion.- References.

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