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Gene therapy potentially represents one of the most important developments in modern medicine. Gene therapy, especially of cancer, has created exciting and elusive areas of therapeutic research in the past decade. In fact, the first gene therapy performed in a human was not against cancer but was performed to a 14 year old child suffering from adenosine deaminase (ADA) deficiency. In addition to cancer gene therapy there are many other diseases and disorders where gene therapy holds exciting and promising opportunities. These include amongst others gene therapy within the central nervous system and the cardiovascular system. Improvements of the efficiency and safety of gene therapy is the major goal of gene therapy development. After the death of Jesse Gelsinger, the first patient in whom death could be directly linked to the viral vector used for the treatment, ethical doubts were raised about the feasibility of gene therapy in humans. Therefore, the ability to direct gene transfer vectors to specific target cells is also a crucial task to be solved and will be important not only to achieve a therapeutic effect but also to limit potential adverse effects.

A micro anatomical and surgical study of the orbit was conducted on cadaver specimens. First of all we reviewed the anatomy of the orbit with special emphasis on microanatomical structures. Three neurosurgical approches are then described with all structures encountered along these routes. The superior approach which provides a good access to the superior part of the orbit is the only route which can explore all parts of the optic nerve even in the optic canal. The lateral compartment of the orbit could be exposed by the lateral approach above or below the lateral rectus muscle. It is the only route that could give access to the inferior part of the orbit. The supero lateral approach is the largest route and has advantages of the two preceding routes. It gives access to the superior part of the orbit but not the optic canal and gives also a good exposition to the lateral part of the orbit but less than the lateral route in the inferior part. These approaches could be used to remove all intra orbital lesions apart from those located in the infero medial part of the orbit.

Orbital tumours are lesions that appear within the orbital craniofacial borders. To this end, treatment of these tumours is assured by teams of different specialists. Furthermore, these pathologies are different in adults and in children. We have endeavoured, in this chapter, to highlight the specifically neurosurgical features of orbital tumours or, to be more precise, tumours affecting the posterior two thirds of the orbit and tumours originating in or intruding into the optic canal. The list of aetiologies is long. After recapitulating the main types of tumour (as well as those of most concern), we have also studied the different stages of surgery, namely approaches and reconstructions which we have illustrated at each stage by a tumour that, in our view, seemed emblematic of the problem in question: the lateral eyebrow approach for schwannoma and cavernous angioma, the transorbital subfrontal approach for optic nerve glioma, the pterional and orbital approaches for spheno-orbital meningioma, problems with reconstruction and with plexiform neurofibroma affecting the orbit and fibrous dysplasia of bone.

Advances in surgical instrumentation and technique have lead to an extensive use of endoscopic third ventriculostomy in the management of pediatric hydrocephalus. The aim of this work was to point out the leading aspects related to this technique. After a review of the history, which is now almost one century last, the analysis of the endoscopic ventricular anatomy is aimed to detail normal findings and possible anatomic variations which might influence the correct conclusion of the procedure. The overview of modern endoscopic instrumentation helps to understand the technical improvements that have contributed to significantly reduce the operative invasiveness. Indications are analysed from a pathogenetic standpoint with the intent to better understand the results reported in the literature. A further part of the paper is dedicated to the neuroradiological and clinical means of outcome evaluation, which are still a matter of debate. Finally a review of transient and permanent surgical complications is performed looking at their occurrence in different hydrocephalus etiologies.

Failed back surgery syndrome has become unfortunately a common clinical entity. FBSS does not have one specific treatment because it does not have one specific cause. Some features are shared with chronic low back pain (CLBP) and some pathological processes are specific. Both pathologies are leading causes of disability in the industrialized world and costly medical and surgical treatments are continuously used despite their limited efficacy. Nonetheless, evidence based practice guidelines are systematically developed.

In this chapter we cautiously review the vast, complex and at times contradictory literature regarding the treatment of FBSS. Interventional Pain literature suggests that there is moderate evidence (small randomized or non randomized or single group or matched case controlled studies) for medial branch neurotomy and limited evidence (non experimental one or more center studies) for intra-discal treatments in mechanical low back pain. There is moderate evidence for the use of transforaminal epidural steroid injections, lumbar percutaneous adhesiolysis and spinal endoscopy for painful lumbar radiculopathy and spinal cord stimulation and intrathecal pumps mostly after spinal surgery. In reality there is no gold standard for the treatment of FBSS but, these results seem promising.

This chapter on surgical anatomy is addressed to young neurosurgeons and could be used as an introduction to basic neurosurgical technique. It aims to cover the basic anatomy relevant to making incisions in the scalp and creating bone flaps, an essential preliminary to any form of intracranial surgery. We will examine the anatomy of the scalp, its arterial and venous supply and its nervous system, as well as providing some technical points related to the cranial vault and the base of the skull. It will be explained how a well-grounded knowledge of the anatomical details makes it possible to execute correctly two of the most common approaches in neurosurgical practice, namely the pterional approach and an approach around the sinuso-jugular axis.