Advances and Technical Standards in Neurosurgery was conceived in 1972byitsfoundingfathersJeanBrihaye,BernardPertuiset,FritzLoew andHugoKrayenbuuhlatacombinedmeetingoftheItalianandGerman NeurosurgicalSocietiesinTaormina. Itwasdesignedtocomplementthe Europeanpost-graduatetrainingsystemforyoungneurosurgeonsandwas ?rst published in 1974 initially through sponsorship by the European AssociationofNeurosurgicalSocieties. Allcontributionshavebeenp- lishedinEnglishtofacilitateinternationalunderstanding. Theambitionofallsuccessiveeditorialboardshasbeentoprovidean opportunityformaturescholarshipandre?ection,notconstrainedbyar- ?ciallimitsonspace. Theseriesprovidesaremarkableaccountofprogress overthepast35years,bothwithregardtoadvances,detaileddescriptions of standard operative procedures and in- depth reviews of established knowledge. Thepresentvolumeisnoexceptionandshouldappealtoboth experiencedneurosurgeonsandyoungneurosurgeonsintrainingalike. TheEditors Contents Listofcontributors…XIII Advances Present and potential future adjuvant issues in high-grade astrocytic glioma 1,2 1 1 2 1 treatment. F. LEFRANC ,M. RYNKOWSKI,O. DEWITTE,andR. KISS, Department ofNeurosurgery,ErasmeUniversityHospital,FreeUniversityofBrussels(U. L. B. ), 2 Brussels,Belgium, LaboratoryofToxicology,InstituteofPharmacy,FreeUniversity ofBrussels(U. L. B. ),Brussels,Belgium Abstract…4 Introduction…5 Naturalresistanceofmigratingmalignantgliomacellstoapoptosis (radiotherapyandchemotherapy)…6 Patternsofcelldeath…8 Autophagy:apotentialTrojanhorseformalignantgliomas…11 Therapeuticbene?tsoftemozolomide…13 Localtherapiesforglioblastomas…15 Ongoingclinicaltrialsforglioblastomas…16 Growthfactorreceptorinhibitors …17 PI3K=Akt,mTORandNF- Binhibitors…17 Matrixmetalloproteinase(MMP)inhibitors(MMPI)…18 Angiogenesistargeting …19 Cellularandvaccinationtherapies…20 Genetherapy…20 Reducingmalignantgliomacellmotilityinordertorestore pro-apoptoticdrugsensitivity…20 Thesodiumpumpconstitutesapotentialtargettocombat malignantgliomas…21 Thesodiumpump…22 Cardiotonicsteroids:ligandsofthesodiumpump…24 VIII Contents Thesodiumpumpisinvolvedincancercellproliferation, migrationanddeath…24 Braintumorstemcellsapotentialtargettocombatmalignantgliomas…26 Conclusions…27 References…2 8 Deepbrainstimulationforpsychiatricdisorders-stateoftheart. T. E. SCHLA APFER and B. H. BEWERNICK, Brain Stimulation Group, Department of Psychiatry and Psychotherapy,UniversityHospitalBonn,GermanyandDepartmentsofPsychiatry andMentalHealth,TheJohnsHopkinsUniversity,MD,USA Abstract…37 Introduction…38 Historyofdeepbrainstimulation…39 PrinciplesofDBS…40 NeurobiologyofdepressionandOCD…41 Neurobiologyofdepression…41 NeurobiologyofOCD…42 StudiesofDBSandpsychiatricdisorders…43 Problemsintargetselection…43 Targetsindepression…43 TargetsinOCD …46 SafetyandadvantagesofDBS…47 EthicalaspectsandstandardsinDBS…51 Ethicalconsiderations…51 ThepathtowardsmandatorystandardsforDBSinpsychiatricdisorders…52 Conclusions…53 ThefutureofDBS…54 References…54 Standards High?owextracranialtointracranialvascularbypassprocedureforgiantan- rysms:indications,surgicaltechnique,complicationsandoutcome. H. C. PATEL and P. J. KIRKPATRICK, Department of Academic Neurosurgery, Addenbrooke’s Hospital,UniversityofCambridge,Cambridge,UK Abstract…61 Introduction…62 Surgicaltechnique…67 Cranialexposure…69 Cervicalexposure…70 Saphenousveinexposure…71 Preauriculartunnel…7 2 Contents IX Anastamoses…73 Distalanastamosis…73 Externalcarotidanastamosis…74 Closureandpostoperativecare…77 Discussion…77 Comparisonofoutcomes…77 Choosingthetypeofgraft…78 Longtermpatencyofgrafts…79 Ischaemiccomplications…79 Anticoagulationrelatedmorbidity…81 Conclusion…