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Spine and peripheral nerves reconstructive
surgery, central nervous system revascularization (surgical,
radiointerventional), neuromodulation, bioengineering and transplantation are
the recent tools to promote reconstruction, restoration and rehabilitation.
The ISRN is an "open"
multidisciplinary Society in evolution. Many different souls inspire new trends
in many different neurosurgical fields, all dealing with "neurosurgical
reconstruction". Spinal, functional, vascular, radio and oncologic neurosurgeons
are the addressees of our proposal along with biologists, bioengineers,
anatomists physiologists, physiotherapists who are precious and irreplaceable
inspirers. These are the three key words of our creed and all fulfill the aim
of ISRN, dealing with mechanical morphological and functional restoration.
Keywords:
Neurosurgical reconstruction, Neurosurgical restoration, Neurosurgical
rehabilitation
INTRODUCTION
Founded in 1955, the WFNS is a professional, scientific,
non-governmental organization comprising 5 Continental Associations, 115
National Neurosurgical Societies and 7 Affiliate Societies, representing some
30,000 neurosurgeons worldwide. The World Federation of Neurosurgical Societies
(WFNS) aspires to promote global improvement in neurosurgical care, training
and research to benefit the patients. The WFNS is governed by an Executive
Committee consisting of two Delegates from each Member Society and an
Administrative Council composed of the Officers of the Federation, who are
elected every four years. The EC meets every two years and is guided by the
Administrative Council which meets at least annually.
The goals
of the WFNS are deliberated and pursued through scientific, standing and ad hoc
committees and during the International Congress of Neurological Surgery which
takes place every four years. The
Neurorehabilitation and Reconstructive Neurosurgery Committee (NRNC) is
a special Section which promotes all those activities of the WFNS aiming at
implement and promote all the restorative, reconstructive and augmentative neurosurgical
procedures, grossly identified in the
past as the Functional Neurosurgery
subspecialty but now updating, evolving
and merging with neuro oncology, spine surgery neuroradiological and
neurophysiological intraoperative assistance and new technologies lato sensu.
As matter of fact the Neuromodulation Committee is a different Section and it
is administered by a completely different Board working in an independent way
and pursuing different objectives. Two years after the institution of the WFNS
Committee, the members of the Board of the Neurorehabilitation and
Reconstructive Neurosurgery Committee felt the need to found a new Society,
more free to deal with other Medical and /or Surgical Societies and expert
researchers of different branches of biology, physiology, physiotherapy. The IV
International Congress of International Society of Reconstructive Neurosurgery
(ISRN) along with the VII
Neurorehabilitation and Reconstructive Neurosurgery Symposium (WFNS) was
held in Cerveteri (Rome) on SEPTEMBER
the 12th – 14th, 2015. The President of
the Congress was Prof Franco TOMASELLO, former Rector of the University of
Messina Italy and actually Vice
President of WFNS and myself Massimiliano VISOCCHI, Past President of the
Italian Society of Neurosonology and Cerebral Haemodinamics, former Secretary
of the Spine Section of the Italian Society of Neurosurgery, Associate
Professor in Neurosurgery at the Catholic University of of Rome and Visiting
Professor at the Shanghai Jiao Tong University School of Medicine. In such an
occasion I was appointed President
Elect of the ISRN and soon after I started to ask to myself some more questions
dealing with Reconstructive Neurosurgery and also to try to better investigate
on the true roots of our Society and the supposed mission of ISRN. In other
words “were we come from? Who are we and where are we going?”
Now, also
as Chairman Elect of the NRNC my main
impulse is to have a look on the current literature on the topic. If we
search for “Reconstructive Neurosurgery” on Pub Med. Gov the US National
Library of Medicine National Institute of Health we can find 3849 papers
updated at April 2018 the 11th. The papers are spanning from the latter,
printed on April 2018 and
harbouring a very intriguing title: Independent factors affecting postoperative
complication rates after custom-made porous hydroxyapatite cranioplasty: a
single-center review of 109 cases [1] to the former, the very first recognized
paper, printed on November 1947 and
dealing with A report of the
early results in tantalum cranioplasty [2]. In between these papers there are
many others dealing with craniofacial endoscopy [3], spinal instrumentation and
fusion procedures [4], perpheral nerves reconstructive procedures [5], vascular
reconstructive and cerebral blood flow restorative surgical procedures [5],
neuronavigation and video assisted neurosurgical procedures [6], craniofacial
complex surgical procedures [7], intraoperative neuromonitoring [8].
Surprisingly many paper dealing with genetics, bio molecular and cytochemical
studies dealing with central and peripheral nervous system are available as
well [9]. Reconstruction is intended in a pure mechanical way and no concepts
dealing with restoration or
rehabilitation arise from the lines of the majority of the manuscripts but just
a simple exposition of surgical techniques and procedures aiming at just
repairing something. More in details even “dysfunctional” syndromes as Raynaud
syndrome are faced with mechanical procedures instead of neuroaugmentative ones
[10].
Neurosurgeons
know very well that central nervous system, along with the spine and the skull
bone components, has an intrinsic pattern of complex physiological nature both
from the neuro - chemical and the
biomechanical point of view. Starting from
the Neurorehabilitation Committee of the WFNS experience, we turned our gaze
toward restoration and rehabilitation very soon and now, since ISRN is an "open"
multidisciplinary Society in evolution, we first intended neurosurgical
reconstruction, latu sensu, in a new way: reconstruction means also
rehabilitation and restoration.
Nevertheless
in the common literature restoration is strongly linked to the concept of
reconstruction as demonstrated by the title of the following paper included in
the Pub Med list of Reconstruction: Restoration of the orbital aesthetic
subunit with the thoracodorsal artery system of flaps in patients undergoing
radiation therapy [11].
Otherwise
neurorehabilitation has different sounds
and significances in the culture of the
neurosurgeons; although it still deal with reconstruction e. g Functional restoration of diaphragmatic
paralysis: an evaluation of phrenic nerve reconstruction [12] and also with replantation as descripted in in the paper Six years of
follow-up after bilateral hand replantation [13], functional
neurorehabilitation merges with the concept of neuromodulation and
neuromodulation is the core of the functional neurosurgery. So more simply
spine and peripheral nerves reconstructive surgery, central nervous system
revascularization (surgical, radiointerventional), neuromodulation,
bioengineering and transplantation are the recent tools to promote
reconstruction in the special sense intended by our Society.
More in
details neuromodulation classically deals with is the physiological process by
which a given neuron uses one or more neurotransmitters to regulate diverse
populations of neurons. This is in contrast to classical synaptic transmission,
in which one presynaptic neuron directly influences a single postsynaptic
partner. Neuromodulators secreted by a small group of neurons diffuse through
large areas of the nervous system, affecting multiple neurons. Otherwise in the
surgical praxis the meaning shifted toward all the surgical tools armamentarium
dealing with all the procedures involved in CNS electrical and chemical
stimulation as performed with spinal cord stimulation (SCS) deep brain
stimulation (DBS), cortical brain stimulation (CBS) drug delivery systems implantation (DDS)
aimed at facing with pain, movement disorders, spasticity, bowel and bladder
dysfunction, peripheral heart and cerebral vasculopaties. Interestingly an
interpherence of SCS was first reported by Hosobuchi in 1986 also with CBF; he
reported the intriguing effect of SCS on CBF in human beings, along with the
demonstration that spinal cord stimulation can improve peripheral blood
flow. Following these initial clinical and experimental observations, he
first described the use of cervical SCS for the treatment of cerebral ischemia
in man in 1991 [14].
Others
have reported that SCS improves clinical symptoms of patients in persistent
vegetative states, improves CBF in stroke patients, suppresses the hemodynamic
mechanism underlying headache attacks in migraneous patients, and increases locoregional blood flow in high
grade brain tumours in humans. In animals, SCS has been shown to prevent
progression of cerebral infarction, reduce infarct volume, reduce ischemic brain
edema and improve vasospasm [15]. Studies of our group have produced variable
results: SCS can produce an increase of
CBF, a reduction or no effect. In patients studied with both single photon
emission cerebral tomography (SPECT) flowmetry and Transcranial Doppler
Sonography (TCD) the size of the induced variations, when present in both, was
the same. Cervical stimulation more frequently produces an increase in CBF (61%
of cervical stimulations) [16-18]. Experimental studies of our group confirmed that
SCS 1) interacts with CO2 with the mechanism of regulation of CBF in a
competitive way and produce a reversible functional sympathectomy; 2) produces
similar flowmetric changes in the brain as well as in the eyes; 3) can improve
both clinical and hemodynamic ischemic stroke in humans, 4) prevents
hemodynamic deterioration in the experimental combined ischemic and traumatic
brain injury; and 5) prevents
experimental early vasospasm [19-21]. On the other hand, trigeminal ganglion
stimulation can have opposite effects [22].
But when
we speak about reconstruction we cannot forget spinal cord and spine surgery,
both surgical challenges, from a bio functional point of view the former and
from a bio mechanical point of view the latter. Instrumentation and fusion
procedures from the upper to the lower levels of the spine have been widely
published so far [23-28]. Nevertheless the choice of altenative miminimally
invasive video assisted surgical routes for spine reconstruction have got also
a big deal of interest and opened new perspectives in reconstruction,
rehabilitation and restoration which are the three key words of our creed and
all fulfill the aim of ISRN, dealing with mechanical morphological and
functional restoration [29-35].
Spinal,
functional, vascular, radio and oncologic neurosurgeons are the addressees of
our proposal along with biologists, bioengineers, anatomists physiologists,
physiotherapists who are precious and irreplaceable inspirers.
- Still M, Kane A, Roux A,
Zanello M, Dezamis E, et al. (2018) Independent factors affecting
postoperative complication rates after custom-made porous hydroxyapatite
cranioplasty: a single-center review of 109 cases. World Neurosurg 18:
S1878-8750.
- Lane S, Webster JE (1947) A report of
the early results in tantalum cranioplasty. J Neurosurg 4: 526-529.
- Sreenath SB, Recinos PF, McClurg SW,
Thorp BD, McKinney KA, et al. (2015) The Endoscopic Endonasal Approach to
the Hypoglossal Canal: The Role of the Eustachian Tube as a Landmark for
Dissection. JAMA Otolaryngol Head Neck Surg 17: 1-8.
- Lim SH, Jo DJ, Kim SM, Lim YJ (2015)
Reconstructive surgery using dual U-shaped rod instrumentation after
posterior en bloc sacral hemiesection for metastatic tumor: case report. J Neurosurg
Spine 31: 1-5.
- Hendry JM, Alvarez-Veronesi MC,
Snyder-Warwick A, Gordon T, Borschel GH (2015) Side-To-Side Nerve Bridges
Support Donor Axon Regeneration Into Chronically Denervated Nerves and Are
Associated With Characteristic Changes in Schwann Cell Phenotype.
Neurosurg.
- Takanari K, Araki Y, Okamoto S, Sato H,
Yagi S, et al. (2015) Operative wound-related complications after cranial
revascularization surgeries. J Neurosurg 3: 1-6.
- Andrews BT, Thurston TE, Tanna N, Broer
PN, Levine JP, et al. (2015) A Multicenter Experience With Image-Guided
Surgical Navigation: Broadening Clinical Indications in Complex
Craniomaxillofacial Surgery. J Craniofac Surg 26: 1136-1139.
- Biscevic M, Biscevic S, Ljuca F, Smrke
BU, Ozturk C, Tiric-Campara M (2014) Motor evoked potentials in 43 high
risk spine deformities. Med Arch 68: 345-349.
- Lopez-Bertoni H, Lal B, Li A, Caplan M,
Guerrero-Cázares H, et al. (2015) DNMT-dependent suppression of microRNA
regulates the induction of GBM tumor-propagating phenotype by Oct4 and
Sox2. Oncogene 34: 3994-4004.
- Merritt WH (2014) Role and rationale for
extended periarterial sympathectomy in the management of severe Raynaud
syndrome: techniques and results. Hand Clin 31: 101-20.
- Chanowski EJ, Casper KA, Eisbruch A,
Heth JA, Marentette LJ, et al. (2013) Restoration of the orbital aesthetic
subunit with the thoracodorsal artery system of flaps in patients
undergoing radiation therapy.J Neurol Surg B Skull Base 74: 279-285.
- Kaufman MR, Elkwood AI, Colicchio AR,
CeCe J, Jarrahy R, et al. (2014) Functional restoration of diaphragmatic
paralysis: an evaluation of phrenic nerve reconstruction. Ann Thorac Surg
97: 260-266.
- Marques M, Correia-Sá I, Festas MJ,
Silva S, Silva AI, et al. (2013) Six years of follow-up after bilateral
hand replantation Chir Main 32: 226-234.
- Hosobuchi Y (1985) Electrical
stimulation of the cervical spinal cord increases cerebral blood flow in
humans. Appl Neurophisyol 48: 372-376.
- Visocchi M (2008) Neuromodulation of
cerebral blood flow by spinal cord elctrical stimulation: the role of the
Italian school and state of art. J Neurosurg Sci 52: 41-47.
- Visocchi M (2006) Spinal cord
stimulation and cerebral haemodynamics. Acta Neurochir
Suppl 99: 111-116.
- Meglio M, Cioni B,
Visocchi M, Nobili F, Rodriguez G, et al. (1991) Spinal cord stimulation
and cerebral haemodynamics. Acta Neurochir 111: 43-48.
- Visocchi M, Argiolas L, Meglio M, Cioni
B, Dal Basso P, et al. (2001) Spinal cord stimulation and early
experimental cerebral spasm: the functional monitoring and the preventing
effect. Acta Neurochir 143: 177- 185.
- Visocchi M, Tartaglione T, Romani R,
Meglio M (2001) Spinal cord stimulation prevents the effects of combined
ischemic and traumatic brain injury. An MR study.
Stereotact Funct Neurosurg 76: 276-281.
- Visocchi M, Cioni B, Pentimalli L,
Meglio M (1994) Increase of cerebral blood flow and improvement of brain
motor control following spinal cord stimulation in ischemic spastic
hemiparesis. Stereotact Funct Neurosurg 62: 103-107.
- Visocchi M (2008) Sympathetic activity
does influence cerebral blood flow J Appl Physiol 105: 1369.
- Visocchi M,
Chiappini F, Cioni B, Meglio M (1996) Cerebral autoregulation and
trigeminal stimulation. A TCD study. Ster Funct Neurosurg 66: 184-192.
- Visocchi M, Di Rocco F, Meglio M (2003)
Craniocervical junction instability: instrumentation and fusion with
titanium rods and sublaminar wires. Effectiveness and failures in personal
experience. Acta Neurochir 145: 265-272.
- Visocchi M,
Pietrini D, Tufo T, Fernandez E, Di Rocco C (2009) Pre-operative
irreducible C1-C2 dislocations: intra-operative reduction and posterior
fixation. The "always posterior strategy". Acta Neurochir 15:
551-560
- Visocchi M, Fernandez EM, Ciampini A, Di
Rocco C (2009) Reducible and irreducible os odontoideum treated with
posterior wiring, instrumentation and fusion. Past or present? Acta
Neuroch 151: 1265-1274.
- Visocchi M (2009) Pre-operative
irreducible C1-C2 dislocations: intra-operative reduction and posterior
fixation. The "always posterior strategy". Acta Neurochir 151:
551-559.
- Visocchi M, Conforti G, Roselli R, La
Rocca G, Spallone A (2015) From less to maximally invasiveness in cervical
spine surgery: A "nightmare" case who deserve consideration. Int J Surg
Case Rep 9: 85-88.
- Visocchi M,
Conforti G, La Rocca G, Roselli R, Spallone A, Barbagallo G (2014)
Invasive and mini-invasive lumbar fusions. Does exist a state of art? An enigma in
search of solutions. J Neurosurg Sci 58: 113-117.
- Visocchi M, Masferrer R, Sonntag VHK
(1998) Dickman: Thoracoscopic approaches to the thoracic spine. Acta
Neurochir 140: 737-744.
- Visocchi M, La Rocca G, Della Pepa GM,
Stigliano E, Costantini A, et al. (2014) Anterior video-assisted approach
to the craniovertebral junction: transnasal or transoral? A cadaver
study.Acta Neurochir 156: 285-292.
- Visocchi M, Doglietto F, Della Pepa GM,
Esposito G, La Rocca G, et al. (2011) Endoscope-assisted microsurgical
transoral approach to the anterior
craniovertebral junction compressive pathologies. Eur Spine J 20: 1518-1525
- Visocchi M, et al. (2011) Video-assisted
microsurgical transoral approach to the craniovertebral junction: personal
experience in childhood. Childs Nerv Syst.
- Visocchi M, Trevisi
G, Iacopino DG, Tamburrini G, Caldarelli M, et al. (2014) Odontoid process and clival
regeneration with Chiari malformation worsening after transoral
decompression: an unexpected and previously unreported cause of
"accordion phenomenon".
Eur Spine J.
- Visocchi M, Di Martino A, Maugeri R,
González Valcárcel I, Grasso V, et al. (2015) Videoassisted anterior
surgical approaches to the craniocervical junction: rationale and clinical
results. Eur Spine J.
- Visocchi M (2015) Transnasal and
transoral approach to the clivus and the craniovertebral junction. J Neurosurg
Sci.
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