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					Modern Neurosurgery: Clinical
Translation of Neuroscience
Advances




 © 2005 by CRC Press LLC
                 Library of Congress Cataloging-in-Publication Data

        Modern neurosurgery : clinical translation of neuroscience advances / edited by Dennis A.
        Turner.
                p. cm. -- (Frontiers in neuroscience)
           Includes bibliographical references and index.
           ISBN 0-8493-1482-8 (alk. paper)
           1. Nervous system--Surgery.
            [DNLM: 1. Neurosurgery--trends. 2. Neurosurgical Procedures--trends. WL 368 M6885
          2004] I. Turner, Dennis A. II. Title. III. Series: Methods & new frontiers in
          neuroscience series.

        RD593.M627 2004
        617.4′8--dc22                                                                  2004045731


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      © 2005 by CRC Press LLC
Foreword and Scope
Advances in clinical neuroscience often arise from a better understanding of brain
function and hypotheses based at the cellular, system, or organ level. Recent empha-
sis is on translating functions or structure-based hypotheses into clinical treatment
schemes. This process of translational research depends on a number of critical
steps, and in most cases, a clinical market that would make commercialization
worthwhile financially. Rather than focus on current treatment schemes, this volume
will critically discuss treatments in the process of development, particularly those
that have arisen or will arise from advances in neuroscience knowledge. The three
categories of such treatments are: (1) treatments, aids, and techniques currently in
clinical trials or pending U.S. Food and Drug Administration (FDA) approval and
new indications for older approved drugs and devices; (2) advances in the promising
preclinical stages that may lead to a rapid progression to initial human trials over
the next 5 to 10 years; and (3) approaches that failed at the clinical application level,
but still offer insights into whether the initial hypothesis was invalid or significantly
flawed in some respect.
     Many of these advances are hypothesis-based, particularly the pharmacological
approaches. However, as a surgical specialty, neurosurgery also has experienced
many technical advances, both in terms of treatment and also for both diagnostic
approaches and aids that enhance the technical performance of surgical procedures.
Such technical advances have led the FDA to devise new methods of approval for
approaches that do not directly entail treatment, for example, aids to performance
of the surgery. Such aids include stereotactic frames, frameless computer-guided
approaches, diagnostic ultrasound, operating microscopes, and many other devices
that highlight the dominant role that technological advances continue to exert in
translating neuroscience into clinical practice. However, even the application of a
new technology requires the identification of a hypothesis. Clear specification of
the underlying hypothesis and associated supportive data may lead logically to
identifying required testing and enhancement of data both for and against a concept.
     This book intends to examine the interface between neuroscience progress and
clinical neuroscience advances by assessing the hypotheses that drive this evolution.
With this hypothesis-based approach, this book will review the relevant neuroscience
underpinnings of new neurosurgical techniques, treatments, and conceptual
approaches that are likely to shape clinical neuroscience over the next decade. This
dynamic approach is a radical departure from more descriptive books on the topic
of 21st century neurological sciences that focus on reviews of current techniques or
treatment schemes with timelines to clinical application greater than 10 years.
     The specific charge to all the chapter authors was to outline and discuss advances
in clinical neurosciences that may occur over the next 5 to 10 years, but are not yet
clinical realities. This horizon includes treatment schemes that may be in early stages


     © 2005 by CRC Press LLC
of clinical adaptation, but the goal is to depart from a review of current clinical
practice. As these advances progress in their translation into clinical practice, clearly
many may not pass the critical steps of possessing sufficient safety, efficacy, market
potential, and usefulness to become marketable items or common practices. Many
excellent concepts developed over the past 10 years failed to generate impacts as
clinical solutions because of unanticipated problems arising in the translation, even
though the underlying hypotheses driving the concepts were excellent. Such concepts
include multiple forms of percutaneous discectomy approaches, the clinical use in
surgery of laser tumor removals and intraventricular glial-derived neurotrophic factor
(GDNF) for Parkinson’s disease. We are hopeful that we have chosen wisely — that
we will not highlight a collection of “white elephant” approaches, but rather will
illustrate broader principles of hypothesis-based neuroscience advances.




     © 2005 by CRC Press LLC
Acknowledgments
I thank Dr. Dragan Dimitrov, whose insight and assistance led to the genesis of this
volume. I am indebted to my patient famiy (Annika, Brita, and Kathleen), whose
tolerance is highly apprciated.




    © 2005 by CRC Press LLC
Editor
Dr. Dennis A. Turner was born in 1950, and received a combined M.D./M.A degree
from Indiana University in 1975. After a residency in neurological surgery from
1976 to 1981, he was a postdoctoral fellow at the University of Oslo from 1981 to
1982.




    © 2005 by CRC Press LLC
Contributors
David Corey Adamson, M.D., M.P.H.,   Larry B. Goldstein, M.D.
Ph.D.                                Duke University Medical Center
Duke University Medical Center       Durham, North Carolina
Durham, North Carolina               Golds004@mc.duke.edu
Adams022@mc.duke.edu
                                     Michael M. Haglund, M.D., Ph.D.
Michael J. Alexander, M.D.           Duke University Medical Center
Duke University Medical Center       Durham, North Carolina
Durham, North Carolina               Haglu001@mc.duke.edu
Michael.Alexander@duke.edu
                                     Jeffrey S. Henn, M.D.
Simon J. Archibald, Ph.D.            University of Florida
Integra Neurosciences                Gainesville, Florida
Plainsboro, New Jersey               jhenn@neurosurgery.uf.edu
sarchibald@Integra-LS.com
                                     Kenneth M. Little, M.D.
Christopher J. Beaver, Ph.D.         Duke University Medical Center
Duke University Medical Center       Durham, North Carolina
Durham, North Carolina               Littl002@mc.duke.edu
cjbeaver@duke.edu
                                     Roger D. Madison, Ph.D.
Dragan F. Dimitrov, M.D.             Duke University Medical Center
787 Pacific Street                   Durham, North Carolina
Monterey, California                 Madis001@mc.duke.edu
dragan.dimitrov@chomp.org
                                     Cheryl A. Miller, Ph.D.
Kelley A. Foster, Ph.D.              Duke University Medical Center
Duke University Medical Center and   Durham, North Carolina
Durham Veterans’ Administration      Nikla001@mc.duke.edu
 Medical Center
Durham, North Carolina               Kent C. New, M.D., Ph.D.
FosterKA@duke.edu                    Duke University Medical Center
                                     Durham, North Carolina
Timothy M. George, M.D.              kentnew@duke.edu
Duke University Medical Center
Durham, North Carolina               Miguel A.L. Nicolelis, M.D., Ph.D.
Georg017@mc.duke.edu                 Duke University Medical Center
                                     Durham, North Carolina
                                     nicolei@neuro.duke.edu


    © 2005 by CRC Press LLC
Laura Niklason, M.D., Ph.D.      Ashok K. Shetty, Ph.D.
Duke University Medical Center   Duke University Medical Center
Durham, North Carolina           Durham, North Carolina
Nikla001@mc.duke.edu             Ashok.Shetty@duke.edu

Parag G. Patil, M.D., Ph.D.      Cheryl Smith, Ph.D.
Duke University Medical Center   Duke University Medical Center
Durham, North Carolina           Durham, North Carolina
Patil003@duke.edu                Smith467@mc.duke.edu

Ricardo Pietrobon, M.D., Ph.D.   Dennis A. Turner, M.A., M.D.
Duke University Medical Center   Duke University Medical Center
Durham, North Carolina           Durham, North Carolina
rpietro@duke.edu                 dennis.turner@duke.edu

Ashutosh A. Pradhan, M.D.        Kevan Van Landingham, M.D.
Duke University Medical Center   Duke University Medical Center
Durham, North Carolina           Durham, North Carolina
Pradh002@mc.duke.edu             Vanla001@mc.duke.edu

William J. Richardson, M.D.      Osama O. Zaidat, M.D.
Duke University Medical Center   Duke University Medical Center
Durham, North Carolina           Durham, North Carolina
William.Richardson@duke.edu      Zaida001@mc.duke.edu

John Sampson, M.D., Ph.D.        Ali Zomorodi, M.D.
Duke University Medical Center   Duke University Medical Center
Durham, North Carolina           Durham, North Carolina
John.Sampson@duke.edu            Zomor001@mc.duke.edu

Lee Selznick, M.D.
Duke University Medical Center
Durham, North Carolina
Selzn001@mc.duke.edu




    © 2005 by CRC Press LLC
Table of Contents
Chapter 1
Neuroscience Hypotheses and Translation into Neurosurgery Practice
Dennis A. Turner and Simon J. Archibald

Chapter 2
Clinical Prospects for Neural Grafting Therapy for Cortical Lesions
Ashutosh A. Pradhan, Ashok K. Shetty, and Dennis A. Turner

Chapter 3
Advances in Treatment of Spinal Cord and Peripheral Nerve Injury
Ali Zomorodi and Roger D. Madison

Chapter 4
Cellular Brain Ischemia and Stroke: Neuroprotection, Metabolism, and New
Strategies for Brain Recovery
Kelley A. Foster, Christopher J. Beaver, Larry B. Goldstein, and Dennis A. Turner

Chapter 5
Imaging and Functional Mapping of Local Circuits and Epilepsy
Kenneth M. Little and Michael M. Haglund

Chapter 6
Pre-ictal Seizure Detection and Demand Treatment Strategies for Epilepsy
Dennis A. Turner, Miguel A.L. Nicolelis, and Kevan Van Landingham

Chapter 7
Neuroprosthetics and Clinical Realization of Brain–Machine Interfaces
Dennis A. Turner, Dragan F. Dimitrov, and Miguel A.L. Nicolelis

Chapter 8
Surgical Treatment of Movement Disorders: DBS, Gene Therapy,
and Beyond
Parag G. Patil and Dennis A. Turner

Chapter 9
Novel Therapeutic Approaches for High-Grade Gliomas
Kent C. New, David Corey Adamson, Lee Selznick, and John Sampson


    © 2005 by CRC Press LLC
Chapter 10
Spinal Dysraphism: The Search For Magic
Timothy M. George and David Corey Adamson

Chapter 11
Delayed Cerebral Vasospasm: Current Hypotheses and Future Treatments
Kent C. New, Cheryl Smith, Laura Niklason, and Dennis A. Turner

Chapter 12
Future Directions of Endovascular Neurosurgery
Osama O. Zaidat and Michael J. Alexander

Chapter 13
Neuroscience ICU Therapeutics
Ashutosh A. Pradhan and Dennis A. Turner

Chapter 14
New Directions and Therapeutics in Surgical Spine Treatment
Dennis A. Turner and William J. Richardson

Chapter 15
Clinical Research in Surgery
Ricardo Pietrobon and Dennis A. Turner

Chapter 16
Neurosurgery Teaching Techniques and Neurosurgical Simulation
Jeffrey S. Henn and Dennis A. Turner




    © 2005 by CRC Press LLC

				
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