References

Aboseif S, Tamaddon K, Chalfin S, Freedman S, Kaptein J (2002) Sacral neuromodulation as an effective treatment for refractory pelvic floor dysfunction. Urol 60 52-56 2. Abrams P, Blaivas JG (1990) Fourth report on the standardization of terminology of lower tract function recommended by the International Continence Society. Int Urogynecol J 1 45-58 Abrams P, Blaivas JG, Fowler CJ, Fourcroys JL, Macdiarmid SA, Siegel SW, Van Kerrebroeck P (2003) The role of neuromodulation in the management of...

Treatment of Olfactory Disorders

The effect of surgery on quantitative olfactory disorders has already been mentioned above. Beside the routine surgery indicated in advanced and medication resistant nasal polyposis, ESS has also been proposed in very particular cases of qualitative olfactory disorders 221, 222 . Leopold was the first to describe the selective excision of the olfactory epithelium in patients suffering from very handicapping phantosmias. These cases, less than two dozen so far, have been carefully selected, and...

Interaction Between Venous Sinus Hypertension and CSF Pressure

The aforementioned recent observations demonstrating a much greater prevalence of venous sinus obstruction in patients with PTS raise the question of what role venous sinus obstruction occupies in the aetiology of PTS. Clearly, in cases of cerebral venous sinus thrombosis the role has been defined. However, the nature of venous sinus obstruction in PTS is different. Both intrinsic and extrinsic lesions have been identified and both characteristically are found in the region of the junction of...

Surgical Risks to the Olfactory System

Chronic rhinosinusitis is the most common chronic inflammatory disease and is frequently associated with impaired sense of smell 198, 199 . When symptomatic patients do not improve on medical treatment, endoscopic sinus surgery (ESS) may be proposed. Nasal polyposis is considered as the ultimate stage of chronic rhinosinusitis for which the mainstay of treatment is medical, but in which ESS plays a part in the majority of cases resistant to medication. Assessment of preoperative olfactory...

Cortical Spreading Depression

The ''Onset'' Phase of CSD Initiation of CSD Leao's observations were made in rabbits under barbiturate anaesthesia, and the stimulus to the cortex was bipolar electrical current delivered from an induction coil, but several other stimuli are also effective. Dialysis through an implanted microcatheter or superfusion of the exposed cortex with potassium chloride (KCl) at 130 mM or more is effective in the rat brain 8 , as is local application of KCl with a wick. Neurosurgeons should also be...

Peri Infarct Depolarisations PIDS

In their 1977 paper Branston et al. 45 referred to spontaneous, transient increases in extracellular potassium ion concentration (Ke) which occurred in the ischaemic penumbra following experimental MCAO. Similar, spontaneous events were later reported in another MCAO preparation, also in a gyrencephalic species 90 . It was suggested then that such events, PIDs 3 or HSDs 1 , were ''not necessarily benign'' 91 , and specific studies have confirmed this page 24 Evolution of PID Patterns with Time...

Adjuvant Analgesics

The term 'adjuvant analgesic' describes a drug that has a primary indication other than pain but is analgesic in some conditions. A large group of such drugs, which are derived from diverse pharmacological classes, is now used to manage non-malignant pain. In the post-operative patients, these drugs may be combined with primary analgesics in any of the three steps of the 'analgesic ladder' to improve the outcome for patients who cannot otherwise attain an acceptable balance between relief and...

Results of Sacral Neuromodulation

To date, effectiveness has been assessed by objective and subjective measures. In evaluating the effectiveness of sacral nerve stimulation, results are frequently discussed according to urge incontinence chronic urinary retention, and chronic pelvic pain. However, subjective measures are difficult to implement because the definition tends to vary from what actual improvement occurs in patients. In a multicenter randomized controlled trial, Schmidt et al. 131 observed at six months after sacral...

Causes and Symptoms of Smell Disorders

Since olfactory disorders or even total olfactory loss are far less of a handicap than blindness or deafness for the person concerned, there have not been many attempts to estimate the percentage of people with olfactory problems. Initial surveys were done with questionnaires and rapid smell tests. They revealed that approximately 1-3 of the population has an olfactory problem 117, 118 . Since most of the decrease in olfactory function, like any other sensory function, is due to aging 119 ,...

The Overactive Bladder

Oab Electrical Stimulation

Until the most recent definition of the International Continence Society ICS , the term of bladder overactivity referred to urodynamic status. The bladder was considered as overactive when objectively shown to contract, spontaneously or on stimulation, during the filling phase of a cystometro-gram while the patient is attempting to inhibit micturition 2 . Furthermore, in the first standardization report, the threshold of 15cmH20 was necessary to conclude that an uninhibited bladder was related...

Historical Evolution of Functional Surgery in Lower Urinary Tract Dysfunction

It was Budge who in 1858 opened up the concept of ''micturition reflex'' by stimulating the nervous system. Thanks to technical improvements made by Oersted in 1820 and especially Faraday in 1821, he was able to activate bladder contractions using an electrical stimulation in the sacral part of the spinal cord 130 . Over a century later in 1972, Friedman 64 performed selective bladder stimulation in animal models by implanting bipolar electrodes in the spinal cord. The preganglionic...

Clinical Application of Sacral Neuromodulation

Neuromodulation of the sacral nerves is a therapeutic option for voiding dysfunction in patients who do not respond to the common non-invasive therapies and in whom disturbance in reflex coordination between the bladder, sphincter and pelvic floor is suspected. The rationale for using electrical stimulation techniques for the treatment of such voiding dysfunction is that this stimulation turns the neurological control mechanism back towards a more functional status. The main indications are...

Magnetic Functional Source Imaging of the Sensorimotor Strip

Sensorimotor Strip

The central sulcus is an important anatomical reference in order to localize the sensorimotor cortical strip. It is important to identify precisely the functional anatomy of these cortical areas with the aim of performing surgical resections in and around these areas without harming the eloquent cortex. In particular space-occupying lesions, as tumours and vascular malformations may deform the cortical anatomy such that pre-operative MRI scans may not be appropriate for the identification of...

Methods and Techniques for Sacral Nerve Stimulation

Sacral Nerve Stimulator Placement

The sacrum is normally composed of five modified vertebrae which are fused together. It is a triangular bone mass extending from the inferior vertebral column and containing the sacral and coccygeal nerves. The skin in the sacral region is usually thick, and the subcutaneous tissue varies in thickness according to the habitus of the individual. It tends to be thinner than that found in the adjacent gluteal and lumbar regions. Situated deep below the superficial fascia are two layers of fibrous...

Venous Sinus Obstruction in Pseudotumor Cerebri Syndrome Cause or Effect

Superior Sagittal Sinus Lesion Scan

Whether venous sinus obstruction in PTS is cause or effect remains unresolved. The experimental and clinical evidence discussed above indicates that there is potential for primary venous sinus pathology to cause PTS and there is also potential for secondary venous sinus obstruction due to raised intracranial pressure. We discuss below the available evidence and also present a unifying theory based on the establishment of a disordered positive feedback cycle. The discussion will centre on the...

Complications of Sacral Neuromodulation

Complications of Peripheral Nerve Evaluation PNE Siegel et al. 143 noted 18.2 of adverse effects in 914 test stimulation procedures. The most common adverse events are lead migration from 11.8 143 to 18.6 143 , technical problems 2.6 and pain 2.1 . One surgical intervention 0.1 was required to remove a test lead electrode that became dislodged during lead removal. Local infection and subcutaneous hematoma are rare 143 . Complications of Sacral Nerve Neuromodulation For chronic sacral...

Contents

List of Depolarisation Phenomena in Traumatic and Ischaemic Brain Injury. A. J. Strong and R. Dardis, Section of Neurosurgery, Department of Clinical Neurosciences, King's College, London, UK Abbreviation History, Definitions and Cortical Spreading The Onset Phase of Initiation of The DC Potential Mass Neuronal Activity Grafstein - Changes in Extracellular Ion Concentrations K e, Na e, Cl e, Changes in Membrane Potential and Conductance During CSD 10 Redistribution of Water Tissue Mode of...