Today, over 500,000 patients have been treated world wide in 250 Gamma Knife Centres in 37 countries each one treating between 150 and 700 patients a year. The current book serves as a textbook, training manual and reference book for those involved in Gamma Knife practice covering the theoretical background, the practical aspects of treatment, the social side of the method and necessary information not only for users but for those who refer to the Gamma Knife. It also covers some aspects of the hospital and social administration required for optimal use of the technology, also looking at the effect of the internet on specialist medical practice. It also presents the completely new Gamma Knife (Perfexion), a new technology which extends the range of the Gamma Knife and will be the treatment standard for the future.

AsanadditiontotheEuropeanpostgraduatetrainingsystemforyoung neurosurgeons, we began to publish in 1974 this series of Advancesand Technical Standards in Neurosurgery which was later sponsored by the EuropeanAssociationofNeurosurgicalSocieties. This series was ?rst discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathersoftheseriesbeingJeanBrihaye,BernardPertuiset,FritzLoewand HugoKrayenbuhl. ThuswereestablishedtheprinciplesofEuropean- operationwhich havebeenbornfromthe Europeanspirit,?ourishedin theEuropeanAssociation,andhavebeenassociatedthroughoutwiththis series. ThefactthattheEnglishlanguageisnowtheinternationalmediumfor communicationatEuropeanscienti?cconferencesisagreatassetinterms ofmutualunderstanding. Thereforewehavedecidedtopublishallcont- butionsinEnglish,regardlessofthenativelanguageoftheauthors. All contributions are submitted to the entire editorial board before publicationofanyvolumeforscrutinyandsuggestionsforrevision. Ourseriesisnotintendedtocompetewiththepublicationsoforiginal scienti?cpapersinotherneurosurgicaljournals. Ourintentionis,rather,to present?eldsofneurosurgeryandrelatedareasinwhichimportantrecent advanceshavebeenmade. Thecontributionsarewrittenbyspecialistsin thegiven?eldsandconstitutethe?rstpartofeachvolume. Inthesecondpartofeachvolume,wepublishdetaileddescriptionsof standardoperativeproceduresandindepthreviewsofestablishedkno- edge in all aspects of neurosurgery, furnished by experienced clinicians. This part is intended primarily to assist young neurosurgeons in their postgraduatetraining. However,weareconvincedthatitwillalsobeu- fultoexperienced,fullytrainedneurosurgeons. We hope therefore that surgeons not only in Europe, but also throughouttheworld,willpro?tbythisseriesofAdvancesandTechnical StandardsinNeurosurgery. TheEditors Contents ListofContributors...XIII Advances .. Gene Technology Based Therapies in the Brain. T. Wirth1,4 and S. Yla- Herttuala1,2,3, 1A. I. Virtanen Institute,University of Kuopio, Kuopio,F- land, 2DepartmentofMedicine,UniversityofKuopioandGeneTherapyUnit, Kuopio, Finland, 3Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland,4ArkTherapeuticsOy,Kuopio,Finland Abstract...3 IntroductiontoGeneTherapy:ThePast,PresentandFuture...4 PotentialAreasforGeneTherapyintheBrain...6 GeneTherapyforParkinson'sDisease...7 GeneTherapyforAlzheimer'sDisease...8 GeneTherapyforVascularBrainDiseases...9 GeneTherapyforBrainTumours...11 ChallengesofGeneTherapyintheBrain...12 GeneTransferVectors...15 ViralGeneTransferVectors...17 Retroviruses...17 HerpesSimplexVirus-1(HSV-1)...17 Adenoviruses...18 Adeno-AssociatedVirus(AAV's)...18 Non-ViralVectors...19 Ethics...20 ConcludingRemarks...21 Acknowledgement...21 References...21 VIII Contents TechnicalStandards AnatomyoftheOrbitanditsSurgicalApproach. G. Hayek,Ph. Mercier,and H. D. Fournier, Laboratory of Anatomy, Faculty of Medicine, University of Angers,Angers,France Abstract...35 Introduction...36 AnatomyoftheOrbit...36 TheOrbitalCavity...36 TheOrbitalFasciaorPeriorbita...38 OrbitalContents...39 OrbitalMuscles...40 TheArteriesoftheOrbit...42 VeinsoftheOrbit...47 NervesoftheOrbit...48 LacrymalGland...55 ApproachRoutestotheOrbit...56 Incision...56 TheLateralApproachRoute...57 OsteoplasticTechniques...58 Non-OsteoplasticTechniques...58 TheSuperiorApproachRoute...60 TheHybridLateral/SuperiorRoute...63 Discussion...

Many questions related to stem cell properties and neural stem cell lineage and differentiation still linger. This second edition revises and expands upon the successful first edition in order to provide the most current, cutting-edge methods of today for the scientists working to answer these questions. The use of these step-by-step, readily reproducible laboratory protocols will allow investigators to produce pure populations that can serve as a means of understanding the biology of neural stem cells and adapting them for transplantation into disease models. This is an excellent source of information and inspiration.

This volume of proceedings contains in their entirety the reports submitted at the 6th International Congress of Minimally Invasive Surgery and the 3rd World Congress of the Academy for Multidisciplinary Neurotraumatology, held concurrently in Nagoya, Japan, in March 2005, and provides valuable insights into the latest innovations in clinical neurosurgery for practitioners from a broad range of disciplines.

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series of Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. This series was first discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathers of the series being Jean Brihaye, Bernard Pertuiset, Fritz Loew and Hugo Krayenbiihl. Thus were established the principles of European co operation which have been born from the European spirit, flourished in the European Association, and have throughout been associated with this series. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publi cation of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume.

This book is an up-to-date reference on all aspects of anticoagulation and hemostasis in neurosurgery. After an opening section on basic principles and drug classes in current use, detailed consideration is given to coagulation issues relevant to all patients, not just neurosurgical ones. The coverage includes, for example, deep vein thrombosis, pulmonary embolism, and disseminated intravascular coagulation. A variety of important issues specific to neurosurgical practice are then addressed, and a summary of current guidelines and best practices is provided. By bringing together the latest knowledge from across the discipline, this book will serve as a sound basis for informed decision making in surgical practice. It will be of daily value for neurosurgeons and trainees worldwide and will also be of interest to emergency room physicians, surgeons in general, critical care physicians, neurologists, and hospital medicine specialists.

Cell-Cycle Mechanisms and Neuronal Cell Death examines the role of cell cycle activation in the molecular mechanisms leading to neuronal degeneration. Leading Authors discuss this topic in relation to the major neurological disorders, including Alzheimer 's disease, stroke and epilepsy. This book serves to gain new insights into the molecular determinants of neuronal death and to establish new targets for therapeutic intervention.

Written by neurosurgery residents for neurosurgery residents, The Neurosurgical Consult Book focuses on the initial care and treatment of the neurosurgical consult patient, providing the key guidance you need when quick clinical management decisions are critical. You'll learn to recognize the acuity of patient presentation and determine how to immediately triage the needs of the patient at an appropriate level of care. This portable, practical guide helps you quickly steer neurosurgical patients to medical stability and safety until a definitive clinical management plan is determined. Features a real-life approach, based on actual consults, with chapters titled by the symptoms and clinical presentation of the patient, not by neurosurgical diagnosis. Begins each chapter with the actual consult notification from the consulting team, mimicking how the neurosurgery provider is notified about a new patient in practice. Presents initial imaging as it occurs in real life-whether imaging has already been done or whether the consulting physician needs guidance on what imaging is needed. Includes "Walking Thoughts", guidance on how to tailor your thoughts toward the most important and pressing issues facing the patients before even meeting them, so that upon evaluation, the most important questions are asked first. Covers the most essential neurosurgical grading scales, key physical exam findings, the systematic thought process behind triage management, and learning points to remember when seeing a particular type of neurosurgical patient. Summarizes evidence-based standards of care and key literature. Stepwise video demonstration of the most common emergent bedside procedures. An excellent learning tool for neurosurgery residents as well as neurosurgery fellows, neurology residents, emergency room providers, neurocritical care providers, registered nurses, clinical fellows, physician assistants, nurse practitioners, clinical nurse specialists, medical students, and nursing students. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, videos, and references from the book on a variety of devices.

This volume of "Advances and Technical Standards in Neurosurgery" is devoted entirely to the spine. Like other volumes in the series, it presents important recent progress in the field and offers detailed descriptions of standard procedures to assist young neurosurgeons. Among the advances considered are approaches to spinal navigation, including intraoperative imaging based navigation, and concepts of spinal robotics. The value of sagittal balance as a parameter for the neurosurgeon is examined, and a novel surgical approach to longitudinal pathologies within the spinal canal is presented. Developments in surgery for kyphosis are also discussed, with a focus on pedicle subtraction osteotomy. The technical standards section critically reviews the latest evidence regarding cervical disc arthroplasty and pedicle-based non-fusion stabilization devices. The book concludes by discussing the treatment of craniovertebral junction instability as a result of juvenile chronic arthritis.

The small neck of the aneurysm afforded an easy surgical attack. An ordinary flat silver clip was placed over the sac and tightly compressed obliterated it completely. The clip was flush with the wall of the carotid artery. The sac, lateral to the silver clip, was then picked up with the forceps and thrombosed by the electocautery. Walter Dandy reporting his successful operation of a posterior communicating aneurysm on March 23, 1937. Walter Dandy's patient left the hospital in good health 2 weeks later, and from his report one may gain the impression that the operation was an easy task. Despite continuous developments during the following decades, it was not until the introduction of the operating microscope and microsurgical techniques that surgical treatment was generally accepted. During the microsurgical era surgical results have continued to improve due to diagnostical, neuroanaesthesi ological, and microsurgical refinements, and improved neurointensive care. Endovascular obliteration has become an important treatment alternative but this has not been included in this particular volume. The purpose of the present supplement of the ACTA NEUROCHIRURGICA is to review some of the elements in the neurosurgical management of patients with aneurysmal subarachnoid haemorrhage that are important for a successful outcome. Professor Helge Nornes has been a major force in the development of new techniques and research strategies in this area for a number of years and has recently retired from the National Hospital in Oslo."

In children, the central nervous system tumors complished through advances in the three main are exceeded in incidence only by leukemia and antineoplastic therapeutic modalities-surgery, are more common than any of the other malig- radiation therapy, and chemotherapy. Improve- nancies of childhood. Childhood central nervous ments in neurosurgical technique concomitant system tumors encompass a range of histo- with improvements in anesthesia and periopera- logic varieties from the histologically benign- tive supportive care have resulted in decreased appearing pilocytic astrocytoma to the extremely morbidity and mortality from neurosurgical malignant-appearing glioblastoma multiforme procedures together with an increased likelihood of accomplishing a gross total resection of and the undifferentiated primitive neuroecto- dermal tumors. Similarly, the biologic behavior tumor. Radiotherapy has evolved from using orthovoltage (200-250 KV) equipment to of childhood brain tumors varies not only ac- cording to histology but also with location of supervoltage equipment with much-improved the tumor and age. Unlike primary central nerv- penetration, thus allowing for the administra- ous system tumors in adults, many varieties of tion of accurate homogeneous high doses to childhood brain tumors have the propensity to large volumes without significant effects on the disseminate via the cerebrospinal fluid path- overlying skin and soft tissues. Preliminary data ways.

In his exceptionally thought-provoking and moving memoir, neurosurgeon Joseph D. Stern explores how personal loss influences the way physicians relate to patients and their families. How does a doctor who deals with the death of patients on a regular basis confront his own loss when his beloved family member is living out her last days? Despite a career as a neurosurgeon, Joseph Stern learned more about the nature of illness and death after his younger sister Victoria developed leukemia than his formal medical training ever taught him. Her death broke down the self-protective barriers he had built to perform his job and led to a profound shift in his approach to medicine. During the year of her illness, Dr. Stern developed a greater awareness of the needs of patients and their families; of the burdens they carry; of the importance of connection, communication, and gratitude; and of what it means to ask the right questions. Grief Connects Us intimately explores the impact of personal loss on physicians and the ways in which they integrate it into their professional lives, providing a blueprint for change that places compassion and empathy at the centre of the practice of medicine.

Integrates basic research and practical clinical information on the neuropsychology of epilepsy under one cover. Provides inside knowledge on how neuropsychological assessments are performed and evaluated. A comprehensive reference that will serve as a clinical resource for working with epilepsy patients. Epilepsy is a prevalent condition affecting approximately 1% of the general population. Its behavioral effects on cognition and memory can be as debilitating as the physical aspects caused by ongoing seizures. This book is intended primarily for clinical neuropsychologists who encounter patients with epilepsy, either through employment in academic medical centers or in general practice. The book is of particular value to those working in a comprehensive epilepsy center, as the volume provides extensive coverage of the many clinical procedures performed in that setting. Procedures reviewed in this volume include neuropsychological testing, the Wada procedures, and brain mapping. Chapters include descriptions of the purpose of these procedures, reviews of the recent literature, clinical vignettes, in addition to concrete recommendations on how to actually conduct the procedures. Many chapters provide examples of test forms and stimuli useful for conducting some of the procedures reviewed in this book. Neurologists and pediatricians will also find this book to be helpful, as many medical practitioners consider the activities of clinical neuropsychologists working in their settings to be somewhat mysterious. This book makes the details of neuropsychological practice in an epilepsy setting more accessible than what has been present in prior literature. Content Level Research Keywords Brain mapping - Children with epilepsy - Cognitive remediation - Epilepsy - Epilepsy in children - FMRI - MEG - Movement disorder - Neuropsychological testing - Refractory seizure - Seizure - Seizure disorder - Wada test Related subjects Neurology - Ne

In this issue of Neurosurgery Clinics, guest editors Drs. David D. Limbrick and Jeffrey Leonard bring their considerable expertise to Chiari I Malformation. Top experts in the field cover key topics such as comorbidities associated with Chiari I malformation; orthostatic intolerance and Chiari I malformation; clinical manifestations of Chiari I malformation; imaging in Chiari I malformation; posterior fossa decompression for Chiari I malformation; and more. Contains 21 relevant, practice-oriented topics sociodemographics of Chiari I malformation; Chiari I malformation and sleep disordered breathing; complex Chiari: diagnosis, evaluation, and treatment; new insights into craniovertebral junction instability in Chiari I malformation; spine deformity associated with Chiari I malformation and syringomyelia; and more. Provides in-depth clinical reviews on Chiari I malformation, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Written and edited by world-renowned experts in the field, Benzel's Spine Surgery: Techniques, Complication Avoidance and Management, 5th Edition, provides expert, step-by-step guidance on the evaluation and management of disorders of the spine. This definitive, two-volume work explores the full spectrum of techniques used in spine surgery, giving you the tools you need to hone your skills and increase your knowledge in this challenging area. Clearly organized and extensively revised throughout, it features contributions from both neurosurgeons and orthopaedic surgeons to present a truly comprehensive approach to spine disease. Offers a thorough overview of the effective management of patients with spinal disorders, including fundamental principles, biomechanics, applied anatomy, instrumentation, pathophysiology of spinal disorders, surgical techniques, motion preservation strategies, non-surgical management, and complication avoidance and management, as well as controversies. Focuses on both pathophysiology and surgical treatment of spine disease, with an increased emphasis on minimally invasive surgery. Contains new features such as key points boxes at the beginning of chapters and algorithms to help streamline the decision making process. Covers today's hot topics in spine surgery, such as health economics, artificial intelligence, predictive analytics, new less invasive techniques including endoscopic spine surgery, and the future of spine surgery. Provides expert coverage of key topics including biomechanics of motion preservation techniques, spinal injuries in sports, biologics in spine fusion surgery, anterior sub-axial cervical fixation and fusion techniques, complex lumbosacropelvic fixation techniques, and many more. Features more than 1,500 high-quality illustrations, as well as new procedural videos on en bloc spondylectomy, minimally invasive endoscopic posterior cervical foraminotomy, cervical total disc replacement, minimally invasive lumbar decompression of stenosis, and more. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

Schmidek and Sweet has been an indispensable reference for neurosurgery training and practice for nearly 50 years, and the 7th Edition of Operative Neurosurgical Techniques continues this tradition of excellence. A new editorial board led by editor-in-chief Dr. Alfredo Quinones-Hinojosa, along with more than 330 internationally acclaimed contributors, ensures that readers stay fully up to date with rapid changes in the field. New chapters, surgical videos, and quick-reference features throughout make this edition a must-have resource for expert procedural guidance for today's practitioners. Discusses indications, operative techniques, complications, and results for nearly every routine and specialized procedure for brain, spinal, and peripheral nerve problems in adult patients. Covers the latest techniques and knowledge in deep brain stimulation for epilepsy, movement disorders, dystonia, and psychiatric disorders; surgical management of blast injuries; invasive electrophysiology in functional neurosurgery; and interventional management of cerebral aneurysms and arterio-venous malformations. Includes new chapters on bypass techniques in vascular disease, previously coiled aneurysms, CSF diversion procedures, surgical management of posterior fossa cystic and membranous obstruction, laser-ablation techniques, and brain stem tumors. Explores hot topics such as wide-awake surgery and ventriculo-peritoneal, ventriculoatrial and ventriculo-pleural shunts. Provides detailed visual guidance with more than 1,600 full-color illustrations and 50 procedural videos. Contains quick-reference boxes with surgical pearls and complications. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

Bandscheibendegeneration.- 1 Klinische und bildgebende Diagnostik des lumbalen Bandscheibenvorfalls.- 2 Lumbaler Bandscheibenvorfall - Konservative oder operative Behandlung?.- 3 Prinzipien der konservativen Behandlung des Bandscheibenvorfalls.- 4 Prinzipien der operativen Behandlung des lumbalen Bandscheibenvorfalls.- 5 Langzeitergebnisse nach konventioneller lumbaler Diskotomie.- 6 Die lumbale Mikrodiskotomie - Indikation, operatives Procedere.- 7 Die Bandscheibenoperation im Lumbaibereich Ergebnisse einer klinischen Nachuntersuchung der perkutanen Laser-Diskusdekompression und der mikrochirurgischen Bandscheibenoperation.- 8 ALPD oder PN - die perkutane Nucleotomie nach Gary Onik Behandlungsergebnisse von 1987-.- 9 Postdiskotomie-Syndrom - Diagnostische Kriterien, morphologisches Korrelat, Therapieansatze.- 10 Kunstliche Bandscheibenimplantate im Bereich der lumbalen Wirbelsaule.- Stabilisierungstechniken der Wirbelsaule.- 11 Dorsale Stabilisierungen.- 12 Ventrale Instrumentationen.- 13 Intervertebrale Fusionen mit Cages.- 14 Endoskopische Zugange zur Brustwirbelsaule.- 15 Mikrochirurgische ventrale Fusionstechniken an der Lendenwirbelsaule.- 16 Computerassistierte Wirbelsaulenchirurgie.- 17 Wirbelsaulenoperationen im offenen.- Spezielle Indikationen.- 18 Frakturstabilisierung im HWS-Bereich.- 19 Traumatologie der thorakolumbalen Wirbelsaule.- 20 Die lumbale Spinalkanalstenose.- 21 Moeglichkeiten der operativen Behandlung kyphotischer Deformitaten der Brust- und Lendenwirbelsaule.- 22 Operative Therapie der thorakolumbalen Spondylodiscitis.- 23 Spondylolisthesis: Reposition und Fusion durch Posterior-only approach.

This book describes the specific surgical techniques currently employed in patients with intractable epilepsy; it also covers the relevant technical aspects of general neurosurgery. All of the approaches associated with the various foci of epilepsy within the cerebral hemispheres are considered, including temporal and frontal lobectomies and corticectomies, parietal and occipital lobe resections, corpus callosotomy, hemispherectomy, and multiple subpial incisions. In addition, an individual chapter is devoted to electrocortical stimulation and functional localization of the so-called eloquent cortex. The more general topics on which guidance is provided include bipolar coagulation (with coverage of the physical principles, strength of the coagulating current, use of coagulation forceps, the advantages of correct irrigation, and use of cottonoid patties) and all of the measures required during the performance of operations under local anesthesia. The book is designed to meet the need for a practically oriented source of precise information on the operative procedures employed in epilepsy patients and will be of special value for neurosurgical residents and fellows.

The long-awaited Second Edition of Kempe's Operative Neurosurgery is being prepared by Dr. Michael Salcman with the assistance of Edward R. Laws, MD (pituitary surgery, epilepsy surgery, peripheral nerve surgery); Roberto Heros, MD (brain surgery, carotid endarterectomy); and Volker Sonntag, MD (spinal surgery). The book will be thoroughly updated and revised, but will preserve the user-friendly aspects of the original book: brevity and ease of practical application in the operating room environment.

The International Brain Hypothermia Symposium 2004was the second time I have had the honor of opening such a gathering on brain hypothermia treatment. It was a great pleasure to greet the participants in the hope that their valuablecontributions would make the Tokyo meeting memorable. Brainhypothermia has long been seen as a promising method that may overcome current limitations on brain resuscitation in patients with severe brain damage. However, although excellentresults have been obtained in experimental animal models, for some reason brain hypothermia has not alwaysbeen successful clinically, and resolving this problem has been a major challenge facing physicians specializing in brain therapies. The ICUmanagement of recent research has uncovered newmechanisms ofbrain damage not seen in animal models, including brain thermo-pooling at temperatures above 40 C in severe brain damage, masking neuronal hypoxia even with normal cerebral blood flow. Stress-related hyper glycemia with brain hypothermia was expected to generate useful results in patients with external injuries, cerebral occlusive stroke, and cardiac arrest. In recent clinical studies of brain hypothermia treatment, many excellent results began being reported on the manage ment of severe brain injury, ischemic stroke, and post-resuscitation after cardiac arrest. However, in clinical brain hypothermia treatment many questions remained about appro priate treatment targets, leu management technique, prevention of complications, control of brain tissue temperature, management of hypothermia insult, and mechanisms underly ing the onset of vegetative states."

An authoritative panel of researchers and clinicians critically reviews the entire field to provide a comprehensive guide to modern brain tumor immunotherapy and thereby enhance future research in this area. The contributors detail many of the key laboratory experiments and clinical protocols that are currently being investigated, integrate the available information from previous and ongoing research, and help define the current status of the field. Topics range from adoptive cellular and antibody-mediated immunotherapy of brain tumors to tumor vaccines and related strategies, and include many vanguard experimental strategies and immunological techniques for studying brain tumor immunotherapy. Cutting-edge and comprehensive, Brain Tumor Immunotherapy brings together all the important recent advances in our understanding of central nervous system tumor immunology and illustrates in powerful detail the many new applications now harnessing the immune response for brain tumor therapeutics.

G. Blasius ftrSt described the anatomic aspects of spinal cord injury (SCI) in 1666. Until thattime, society had totally ignored the physically disabled, let alone allowed them to mingle socially and sexually. ThemilitaIymortalityratebetween 1814-1914wasestimatedto be50-80%, although sexualandsocioculturalimplicationswere not addressed. Ina1928novel, Lady Chatterley's Lover, D.H.Lawrence stronglyreflected the sexual concernsofa paraplegic who had been labeled impotent The modern managementofSCI was initiated by Monroe and Guttman in 1943, but with heavy emphasis on physical and urological rehabilitation and only supetficial attention to sexual dysfunctions. H. W. Home et al. started the investigation of SCI infertilityproblems in1950. Itwasnotuntil1960thatBorsandComarr collaboratedonastudythatclassifiedthetypesofsexualdysfunctions inrelation toneurologicallevelsoflesionsfollowing spinalcooltrauma. Nonnal (nondisabled)sexualitycameofageduring thepasttwo decades.Thiswashighlightedbythe 1966publicationofW.Masters', HumanSexualResponse. However, thetopicofsexualityinphysically challenged(handicapped)personsremainslargelytabooinourpresent society. Thereareanestimated10-12millionSCIpersonsworldwide. InAmerica, thereareapproximately1.2-1.5millionSCIvictims, with an annual incidenceof12,000-15,000, oroneevery 35minutes. The visibility of SCI persons was enhanced when the United Nations declared 1980-1990as thedecadeofdisabledpersons. Furthennore, theenactmentintolaw, inJuly, 1990, ofthe AmericanDisabilities Act, pointed out the handicapped person's right to the fullest pursuit of happiness. Since the release in 1974of K. Heslinga's Not Made of v vi Preface Stone, only a handful ofbooks on medical sexuality for the disabled have been published. This book has three majorobjectives: 1. toprovidethoroughandcomprehensivecoverageofdisabled persons' sexuality in all sexual orientations; 2. to introduce new tenninologies and theories, to redefine certainsexualdysfunctions, and todescribeupdatedtreatment formats; and 3. topresentresearchandinnovationsthatmaystimulatefurther investigationsintodisabled sexualityduring the nextdecade. The first partofthis bookdefines new sexual terminology and describes the full spectrumofsa sexual challenges. Thesecondhalfofthebookdealswithavarietyofdiagnosticand therapeutic sexual innovations, AIDS implications, and cosmic sex ology. Finally, the Appendix lists international sexual referral centers and informationorganizations."

The current concept of dystonic movement connects the abnormal function of somatosensory pathways and somatosensory analyzers with the dystonic performance of motor action, which is based on the abnormality of sensorimotor integration. This concept is reflected not only in idiopathic dystonia, but also in secondary and symptomatic dystonias. This bookwill give a comprehensive account ofthe history of the terms dystonia and dystonic, the physiology of dystonic movement, and the genetics and clinical appearance of primary and secondary dystonias. Taking into considerationlatest research findings, Dystonia and Dystonic Syndromes offers an in-depth discussion of current treatment options available for dystonia, including pharmacotherapy, surgery, and neurorehabilitation. Therefore, it serves as a valuable reference for practitioners in the fields of neurology, neurosurgery, psychiatry, and neuroradiology as well as for neuroscientists.

Having been originally introduced as a term to facilitate discussion of a specific group of patients regarded as entering a state of unawareness following coma, the 'Persistent Vegetative State' (PVS) has established itself as an apparently discrete medical condition with clear-cut implications for ethicists and lawyers that exceed any scientifically based understanding. As a consequence of this upgrading, conclusions drawn about the status and hence the management of this uncommon condition have been increasingly extended to other patients with much more common forms of disability. This book traces the origins of prevailing perceptions about PVS and submits these to critical examination. In doing this it comes to the conclusion that inadequate attention has been paid to acknowledging what is not known about affected individuals and that assumptions have consistently come to be traded as facts. Re-examination of the basis of the PVS and the adoption of a more scientific approach is long overdue and is owed to the community at large which has generally been provided by many medical practitioners with a 'dumbed-down' account of the condition. The book will be of interest to philosophers, medical graduates and neuroscientists but is also intended to remain accessible to the general reader with an interest in the wider implications of trends in medical thinking for attitudes towards many classes of patient. It has an extensive bibliography and will be of specific interest to bioethicists and lawyers with professional interests in PVS.