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Traumatic loss of bone substance or post — decompression defects require the reconstruction of the skull. In cases of simple geometry there are handy, secure and cost effective procedures such as using autologuous cryopreserved bone flaps or polymerized Methylmethacrylat. For large sized defects CAD — taylored implants developed to provide a comfortable procedure to ensure high biocompatibility and perfect anatomical results by one — stage surgery. Furthermore cranioplasty does not only imply anatomical reconstruction but also functional recovery of awareness, cognition and motoric functions as shown in several studies according to changes in cerebral hemodynamics and metabolism. In our series of 286 patients who underwent cranioplasty during the past 10 years (1993– 2003) we used taylored implants in 15 cases starting in 1999. All the patients included showed large sized defects > 64 cm^2, complications did not occur neither during surgery nor the postoperative course, cosmetical results were excellent in all the patients. Neurological findings and the functional state improved in 11/15 patients, 4/15 patients showed no change, nevertheless these patients had reached a good recovery before surgery. Application of this technique is limited by cost, nonetheless it is recommended for extensive reconstruction of the skull.

While Neurotrauma is a growing public health problem worldwide, governments have not been able to respond to the silent epidemic of brain injury. Neurotrauma, according to the World Health Organization, will surpass many diseases as the major cause of death and disability by the year 2020. Not-for-profit organizations, professional societies and foundations have begun to address the problem of Neurotrauma through educational conferences, training seminars, prevention activities, passage of laws and regulations, and by providing grant funding. Private sector partnerships with government entities appear to be a significant means of addressing a major public health problem.

Brachial plexus injuries (B.p.i.) are lesions occurring more and more frequently due to high velocity road and sport traumas. They are severe lesions with disabling sequelae. Surgical procedures and results could greatly be improved in the last 2 decades. Although the anatomy of brachial plexus is well known, less known are the functional maps of the various brachial plexus elements. In this paper treatment modalities for obstetrical, traumatic (adult) and actinic B.p.i. are being described too.

None of the currently used techniques for elbow flexion recovery in brachial plexus recovery offers enough strength for normal life activities. The association between several methods grants a better result by a summarizing effect compared to each method used separately. The paper reveals the improvement of the functional results in brachial plexus reconstruction by combining the techniques of nerve repair (nerve grafts, nerve transfers or direct muscular neurotization) with palliative muscular transfers. Of the 54 cases of microsurgical reconstruction of brachial plexus palsy, in 20 cases we associated a muscular transposition: 7 latissimus dorsi transfers (5 monopolar and 2 bipolar), 5 pectoralis major and 8 triceps transfers. The direct neuro-muscular neurotization of the biceps — EMG efficient — was associated with a muscular transfer in 8 cases: in 4 of the 7 latissimus dorsi transfers, in 3 cases of triceps transfer and in 2 case of pectoralis major transfer. The association of the 3 methods — direct neuromuscular neurotization, neuro-neuronal neurotization and muscular transfer — has a summarizing effect in the flexion restoration of the elbow flexion, which represents a major problem in the brachial plexus palsy.

The failure of the spinal cord to recover after injury has been associated with the immune privilege mechanism that suppresses immune activity throughout the central nervous system. Primed macrophages and dendritic cells were shown to promote neurological recovery in preclinical models of spinal cord injury. A cell therapy consisting of autologous incubated macrophages is now being tested on spinal cord injury patients in clinical trials.

Recently the K^+ channel blocker 4-aminopyridine (4-AP) has been suggested to be useful to improve motor deficits due to spinal cord lesions. There is, however, little basic research support for this action of 4-AP. In this study we have used as a model the neonatal mammalian spinal cord in vitro that generates a rhythmic activity termed fictive locomotion (induced by bath-application of NMDA + 5-HT) with phasic electrical discharges alternating between flexor and extensor motor pools and between left and right motoneurons within the same segment. When 4-AP was added in the presence of sub-threshold concentrations of NMDA + 5-HT, there was facilitation of fictive locomotion which appeared with alternating patterns on all recorded ventral roots (VR). Furthermore, in the presence of 4-AP, weak dorsal root (DR) stimuli, previously insufficient to activate locomotor patterns, generated alternating discharges from various VRs. The present data show that 4-AP could strongly facilitate the locomotor program initiated by neurochemicals or electrical stimuli, indicating that the spinal locomotor network is a very sensitive target for the action of 4-AP.

This paper provides an overview on various alternative, complementary, or energy-based therapies that expand the healing spectrum of individuals with spinal cord injury (SCI). Not only do they have the capability to help a variety of secondary conditions, they have the ability in some people, for certain injuries, to restore function, sometimes dramatically. After providing an overall contextual rationale for the use of alternative medicine, this paper briefly summarizes various Eastern-medicine healing modalities, laser-based therapies, nutritional and homeopathic approaches, and pulsed electromagnetic therapies.

Purpose Present the possibility for treatment of male infertility, spasticity, and neurogenic detrusor overactivity in spinal cord lesioned (SCL) individuals with penile vibratory stimulation (PVS). Method Obtaining reflex-ejaculation by PVS, by using a vibrator developed for this purpose. The stimulation was performed with a vibrating disc of hard plastic placed against the frenulum of the penis (amplitude ≥ 2.5 mm). The vibration continued until antegrade ejaculation or for a maximum of 3 minutes followed by a pause of 1 minute before the cycle was repeated, maximally 4 times. Results >80% SCL men are able to obtain ejaculation with PVS. Pregnancy rates obtained with home PVS and intra-vaginal insemination was 22–62% (4 studies), and with PVS or electroejaculation and intrauterine insemination/in-vitro fertilization/intracytoplasmatic sperm injection 39–64% (9 studies). PVS was demonstrated to decrease spasticity significantly when measured by the modified Ashworth scale. In addition, a decrease of the number of spontaneous EMG events which probably indicate spasms was observed. Increase in bladder capacity at leakpoint following 4 weeks of frequent ejaculation with PVS treatment was likewise demonstrated. Conclusion PVS has proved its importance for SCL male fertility, in the years to come its place in treatment of spasticity and neurogenic detrusor overactivity has to be established.

Post-traumatic syringomyelia (PTS) is relatively rare, but its complications can be serious. In the beginning of the operative treatment (1900–1930), scarring could be reduced to a certain degree. In modern treatment (1980–1990) a shunt implantation showed also little effect in long-term follow-up studies. Influenced by the work of B. Williams, 58 PTS patients underwent surgery to create a pseudomeningomyelocele, an artificial CSF reservoir, performed to normalize the CSF flow. In a 10-year-postoperative follow-up study (minimum observation two years), good results were obtained in more than 70%.

Today, thanks to intensive care treatment and modern diagnostic tools, increasingly more patients with severe brain and spinal cord lesions, mainly secondary to accidents, stroke, tumours, and congenital malformations survive the acute impact on the central nervous system (CNS). Complicated operative procedures and concomitant complication may also lead to severe impairment of the sensory motor and cognitive behavioural functioning as it can be described according to the WHO-ICF criteria. New developments of functional neurorehabilitation in neurosurgery can significantly improve patients’ quality of life (QoL) in terms of both brain and body functioning and certain health-related components of well-being (such as social activities and leisure). Rehabilitation starts with assessment of the functional impairment and the underlying pathophysiology by using all modern diagnostic tools. Our concept of postoperative neurorehabilitation is exemplarily demonstrated in one patient who suffered from acute postoperative locked-in syndrome. Surgical decompression and fusion were required for post traumatic and recurrent congenital craniovertebral instability at C0–C1. Subsequent functional neurorehabilitation is based on careful planning in accordance with our concept of a holistic Spectrum of functional early Neurorehabilitation (Fig. 1) [ 9 ][ 10 ].