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 This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. 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Visit the CRC Press Web site at www.crcpress.com © 2005 by CRC Press LLC No claim to original U.S. Government works International Standard Book Number 0-8493-1482-8 Library of Congress Card Number 2004045731 Printed in the United States of America 1 2 3 4 5 6 7 8 9 0 Printed on acid-free paper © 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 [email protected] [email protected] 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 [email protected] [email protected] Jeffrey S. Henn, M.D. Simon J. Archibald, Ph.D. University of Florida Integra Neurosciences Gainesville, Florida Plainsboro, New Jersey [email protected] [email protected] Kenneth M. Little, M.D. Christopher J. Beaver, Ph.D. Duke University Medical Center Duke University Medical Center Durham, North Carolina Durham, North Carolina [email protected] [email protected] Roger D. Madison, Ph.D. Dragan F. Dimitrov, M.D. Duke University Medical Center 787 Pacific Street Durham, North Carolina Monterey, California [email protected] [email protected] 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 [email protected] Medical Center Durham, North Carolina Kent C. New, M.D., Ph.D. [email protected] Duke University Medical Center Durham, North Carolina Timothy M. George, M.D. [email protected] Duke University Medical Center Durham, North Carolina Miguel A.L. Nicolelis, M.D., Ph.D. [email protected] Duke University Medical Center Durham, North Carolina [email protected] © 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 [email protected] [email protected] 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 [email protected] [email protected] 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 [email protected] [email protected] Ashutosh A. Pradhan, M.D. Kevan Van Landingham, M.D. Duke University Medical Center Duke University Medical Center Durham, North Carolina Durham, North Carolina [email protected] [email protected] William J. Richardson, M.D. Osama O. Zaidat, M.D. Duke University Medical Center Duke University Medical Center Durham, North Carolina Durham, North Carolina [email protected] [email protected] John Sampson, M.D., Ph.D. Ali Zomorodi, M.D. Duke University Medical Center Duke University Medical Center Durham, North Carolina Durham, North Carolina [email protected] [email protected] Lee Selznick, M.D. Duke University Medical Center Durham, North Carolina [email protected] © 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 DennisA. 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, LarryB.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 MiguelA.L. Nicolelis Chapter 8 Surgical Treatment of Movement Disorders: DBS, Gene Therapy, andBeyond 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: TheSearch 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 ofEndovascular 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 inSurgery 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