By Johannes Schramm
This quantity of Advances and Technical criteria in Neurosurgery covers a few very important new advancements in sensible neurosurgery and endovascular treatment. within the Technical criteria part numerous issues are thought of, together with optic pathway gliomas, pineal lesions, cavernous sinus meningiomas and the everlasting challenge of sweet sixteen and repetitive head damage. Endovascular therapy of quite a few lesions is now universal perform and the state-of-the-art in endovascular therapy for acute ischemic stroke is reviewed. An appraisal of the proof on even if there's a position for microsurgical vascular decompression for crucial high blood pressure increases fascinating questions. the quantity is finished via contributions on neurosurgical therapy of cluster complications and occipital nerve stimulation.
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Described initially by Melzack and Wall in 1965, the gate control theory describes the enhancement of inhibitory actions of the local circuit neurons in the dorsal horn on the central transmission cells. Stimulation of somatosensory pathways, such as the peripheral nerves or dorsal columns, results in activation of large myelinated afferents (Aß fibers), which “close the pain gate” in the substantia gelatinosa, by enhancing the inhibitory actions of local circuit neurons in the dorsal horn on central transmission cells.
Ultimately, peripheral neurostimulation may exert its effect by multiple mechanisms, which may differ in the various headache and pain syndromes . One theory postulates the involvement of the trigeminocervical system – the anatomic overlap of the trigeminal and occipital afferent systems at the spinal cord vertebral level of C2. These afferents have been cited to converge on second-order nociceptors in the spinal trigeminal nucleus. As such, trigeminal afferent pathways, and thereby primary headache disorders, may be controlled at the C2 level by occipitally mediated afferents.