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."

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 of European co Hugo Krayenbtihl. Thus were established the principles 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.

In addition to surgery and radiotherapy, local treatment modalities for the management of brain tumours are increasingly being developed and clinically tested. This book describes for the first time basic tumour biology as well as all current procedures in progress at the most recent level of knowledge, presented by leading experts in the respective fields. Image guided resection procedures, fluorescence guided surgery, developments in interstitial radiosurgery are addressed, just as intracavitary chemotherapy and all current concepts and studies of interstitial targeted therapy. Owing to its topicality this book will remain for long the standard for this comprehensively treated subject.

INHALT: The Concept of the BBB: an Historical Perspective Anatomy of the BBB Pathophysiology of BBB * Brain oedema Breakdown of the BBB BBB Dysfunction after SAH * Clinical Monitoring Neuroradiological Evaluations of BBB Dysfunction after SAH * Computerised Tomography and Magnetic Resonance * SPECT and PET Experimental Data * Literature Review of BBB Dysfunction after Experimental SAH * Qualitative Assessments * Quantitative Assessments * Time Course of BBB Dysfunction after SAH * Additional Pathophysiological Changes after SAH - Cerebral Vasospasm - CSF Eicosanoids - Cerebral Metabolism - Behavioural and Neurological Deficits - Intracranial Pressure - Blood Pressure, Blood Gases, Plasma pH, Plasma Glucose, Body Temperature Strategies for Pharmacological Interventions * Hydroxyl Radical Scavenger AVS * Glutamate Antagonist Felbamate * Calpain Inhibitor II Challenges and Future Directions * Advances in Cerebrovascular Pathophysiology Elucidation * Gene Therapy

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."

It was only in 1980 that the first recognisable magnetic resonance images of the human brain were published, by Moore and Holland from Nottingham University in England. There then followed a number of clinical trials of brain imaging, the most notable from the Hammersmith Hospital in London using a system designed by EMI, the original manufacturers of the first CT machines. A true revolution in medicine has ensued; in only a few years there are thousands of scanning units, and magnetic resonance imaging (MRI) has assumed a central importance in medical investigation. It is an extraordinary fact that within a few years of development, the esoteric physics of nuclear spin, angular momentum, and magnetic vector precession were harnessed to provide exquisite images of living anatomy; modem science has no greater tribute. That indisputable king of neurology and the oldest of recorded conditions, epilepsy, has not been untouched by the new technology; indeed, it is our view that the introduction of MRI of electroencephalography (EEG) in the late has been as important to epilepsy as was that 1930s. Now, for the first time, the structural and aetiological basis of the condition is susceptible to thorough investigation, and MRI can provide structural detail to parallel the functional detail of EEG. MRI has the same potential as had EEG over 50 years ago, to provide a new level of understanding of the basic mechanisms, the clinical features and the treatment of epilepsy.

It is estimated that the functionally significant body of knowledge for a given medical specialty changes radically every 8 years. New specialties and "sub specialization" are occurring at approximately an equal rate. Historically, estab lished journals have not been able either to absorb this increase in publishable material or to extend their readership to the new specialists. International and national meetings, symposia and seminars, workshops, and newsletters success fully bring to the attention of physicians within developing specialties what is occurring, but generally only in demonstration form without providing historical perspective, pathoanatomical correlates, or extensive discussion. Page and time limitations oblige the authors to present only the essence of their material. Pediatric neurosurgery is an example of a specialty that has developed during the past 15 years. Over this period, neurosurgeons have obtained special train ing in pediatric neurosurgery, and then dedicated themselves primarily to its practice. Centers, Chairs, and educational programs have been established as groups of neurosurgeons in different countries throughout the world organized themselves respectively into national and international societies for pediatric neurosurgery. These events were both preceded and followed by specialized courses, national and international journals, and ever-increasing clinical and investigative studies into all aspects of surgically treatable diseases of the child's nervous system."

"Spasticity is one of the commonest sequelae of neurological disease and during the last few years many advances have been made in the treatment of this complaint by functional neurosurgery. This book ... will appeal to neurosurgeons, orthopaedic surgeons and neurologists amongst others. Annals of the Royal College of Surgeons of England"

This 'in vivo' atlas contains more than 50 magnetic resonance (MR) images of the brain. Each structure is represented in the axial, coronal and sagittal plane, magnified in colour schemes and reconstructed in 3D images with a useful millimetric scale. The atlas offers the reader a practical and simple tool for surgical planning and for diagnostic and anatomical studies. The high level of anatomical definition of the in vivo MR images means that there is no loss in precision as a result of post-mortem changes. No doubt, this book is an excellent teaching instrument for all students of the neurosciences, regardless of the individual level of training and expertise.

Recent breakthroughs in understanding the effectiveness of brain hypothermia treatment have been brought about by rapid progress in experimental gene studies along with new findings in the areas of brain-injury mechanisms, brain thermo-pooling, hemoglobin dysfunction, insulin-resistant hyperglycemia, radical damage involving states of consciousness, management of lipid-dominant metabolism in the intensive care unit (ICU), and management of immune crises under conditions of hypothermia. This book explains the mechanism of brain hypothermia and presents advanced techniques for ICU management of brain hypothermia for critically brain-injured patients. Especially useful for bedside care in the ICU are the easy-reference care-management "cards" in the appendix of the book. Brain Hypothermia Treatment provides a valuable resource and practical guide for professionals in the fields of neurosurgery and emergency and critical care medicine.

The title of this monograph, Brain Tumor Research and Therapy, is the name of the Conference itself, which had its inaugural meeting in the United States in 1975 andhas since progressed to the international scale. In Japan, the first conference ofits kind was organized by Dr. Takao Hoshino and me and was held at Nikko in 1980, hence its name, the Nikko Conference on Brain Tumor Research and Therapy. Though it started as a small, closed meeting, the conference has grown considerably, and in 1992 it was reorganized as the Japanese Conference on Brain Tumor Research and Therapy and was opened to all neurosurgeons and neuropathologists interested in the study of brain tumor problems and who are participating in this field. The main purpose of the Conference on Brain Tumor Research and Therapy is the candid and informed discussion of the most up-to-date developments in basic re search and clinical treatment of brain tumors. The 3rd Japanese Conference on Brain Tumor Research and Therapy was held at Nasu (Tochigi Prefecture), Japan, in No vember 1994. It was a great honor to welcome many distinguished guests from over seas who kindly attended each session and made valuable contributions.

* . . . . At last the doctor will be freed from the tedious interpretation of screens and photographs. Instead, he will examine and scan through his patient directly. Wearing optical-shutter spectacles and aiming a pulsed laser torch, he will be able to peer at the beating heart, study the movement of a joint or the flexing of a muscle, press on suspect areas to see how the organs beneath respond, check that pills have been correctly swallowed or that an implant is savely in place, and so on. A patient wearing white cotton or nylon clothes that scatter but hardly absorb light, may not even have to undress . . . . *. David Jones, Nature (1990) 348:290 Optical imaging of the brain is a rapidly growing field of heterogenous techniques that has attracted considerable interest recently due to a number of theoretical advantages in comparison with other brain imaging modalities: it uses non ionizing radiation, offers high spatial and temporal resolution, and supplies new types of metabolic and functional information. From a practical standpoint it is important that bedside examinations seem feasible and that the implementations will be considerably less expensive compared with competing techniques. In October 1991, a symposium was held at the Eibsee near Garmisch, Germany to bring together the leading scientists in this new field.

Some 29 scientists from the fields of neuroanatomy, neurochemistry, neu rophysiology, neuropharmacology, and behavior have contributed their ef forts to this testimonial on behalf of the contributions made by Dr. F. W. L. Kerr to science and to those with whom he interacted. The intention of the contributors to this volume was to deal with the manifold advances that pertain to the substrates in spinal cord relating to the processing of sensory infor mation, a subject that in one form or another provoked time and again Kerr's native enthusiasm for research. The organization of the book follows a natural course from the peripheral innervation of the somatic and visceral organs (Winkelmann, Chapter 2) to the effective stimuli that activate these fibers and give rise to sensation under normal and pathological conditions (Campbell and Meyer, Chapter 3; Dubner and colleagues, Chapter 13; Dyck, Chapter 14) to the course these afferent systems take to enter the spinal cord (Coggeshall, Chapter 4) and to the organization of the systems through which this afferent information reaches the brain (Willis, Chapter 11; Vierck and colleagues, Chapter 12)."

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series devoted to Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. 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 publication 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. In the second part of each volume, we publish detailed descriptions of standard operative procedures, furnished by experienced clinicians; in these articles the authors describe the techniques they employ and explain the advantages, difficulties and risks involved in the various procedures. This part is intended primarily to assist young neurosurgeons in their post graduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons."

The intracarotid amobarbital (or Amytal) procedure is commonly referred to as the Wada test in tribute to Juhn Wada, the physician who devised the technique and performed the fIrst basic animal research and clinical studies with this method. Wada testing has become an integral part of the pre operative evaluation for epilepsy surgery. Interestingly, however, Wada initially developed this method as a technique to assess language dominance in psychiatric patients in order that electroconvulsant therapy could be applied unilaterally to the non-dominant hemisphere. Epilepsy surgery has matured as a viable treatment for intractable seizures and is no longer confmed to a few major universities and medical institutes. Yet, as is increasingly clear by examining the surveys of approaches used by epilepsy surgery centers (e.g., Rausch, 1987; Snyder, Novelly, & Harris, 1990), there is not only great heterogeneity in the methods used during Wada testing to assess language and memory functions, but there also seems to be a lack of consensus regarding the theoretical assumptions, and perhaps, even the goals of this procedure.

In August of 1991, a second Dartmouth International Workshop on the corpus callosum was convened to share and discuss the progress that had been made over the decade that had passed following the first workshop. A nucleus of basic and clinical scientists came together to discuss their work and the work of others in a field that has been broadened clinically by the addition of many new centers throughout the world that are now performing corpus callosotomy for intractable epilepsy. This text was stimulated by the participants' presentations and associated fertile discussions. It is compiled from the conference and subsequent studies. It reflects, both at the basic and clinical level, an important and expanding field of neural science endeavor. In keeping with the present and rapidly expanding field of outcomes assessment, callosotomy is again evaluated in light of a further decade of surgery and follow-up. Callosotomy continues to be a useful, palliative procedure and the indications for its use have been better established. The basic science section is a supplement to the first edition and elaborates progress in both new data and ideas. The section on experimental epilepsy models adds further support to the clinical rationale for callosotomy. Perhaps of greater importance is the contribution of experimental models to our understanding of the propagation of seizure activity. The section on the neuropsychology of the split brain patient demonstrates the continuing major contributions to the understanding of brain and behavior that pour forth from this cornucopia.

Thousands of people from more than eighty countries have traveled to China since 2001 to undergo fetal cell transplantation. Galvanized by the potential of stem and fetal cells to regenerate damaged neurons and restore lost bodily functions, people grappling with paralysis and neurodegenerative disorders have ignored the warnings of doctors and scientists back home in order to stake their futures on a Chinese experiment. Biomedical Odysseys looks at why and how these individuals have entrusted their lives to Chinese neurosurgeons operating on the forefront of experimental medicine, in a world where technologies and risks move faster than laws can keep pace. Priscilla Song shows how cutting-edge medicine is not just about the latest advances in biomedical science but also encompasses transformations in online patient activism, surgical intervention, and borderline experiments in health care bureaucracy. Bringing together a decade of ethnographic research in hospital wards, laboratories, and online patient discussion forums, Song opens up important theoretical and methodological horizons in the anthropology of science, technology, and medicine. She illuminates how poignant journeys in search of fetal cell cures become tangled in complex webs of digital mediation, the entrepreneurial logics of postsocialist medicine, and fraught debates about the ethics of clinical experimentation. Using innovative methods to track the border-crossing quests of Chinese clinicians and their patients from around the world, Biomedical Odysseys is the first book to map the transnational life of fetal cell therapies.

Professor Philip Bromage From the earliest stirrings of modern surgical anesthesia, novice surgeons struggling to learn from the living what there was a strong intuitive feeling that anesthesia of part they were denied an opportunity to learn from the dead_ of the body would be better for the patient than complete But that is largely nostalgia for a past era_ Today, the visual anesthesia of the whole organism. In 1848, James Young arts and the plastics industry have united to give us superb Simpson spent some time and effort seeking this elusive teaching models and techniques that did not exist a few goal, but after a few ingenious though unsuccessful experi decades ago, and they have developed two- and three ments, he gave up the search and turned back to general dimensional surrogate cadavers that are imbued with a anesthesia as the only practical solution to surgical pain more vivid artistry than ever existed on the marble slabs relief at that time_ amid the formalin reek of our old dissecting rooms_ earl Koller's simple but brilliant application of cocaine to This book is a fresh and highly successful attempt to repair some of the bridges that were burnt with the passing of the the eye in 1884 opened the door to a whole new universe of neural anatomy and pharmacology_ Within a decade or old anatomy days_ Together, the authors have contributed"

The advent in the 1960s of the unique and exciting new form of energy called laser brought to medicine a marvelous tool that could accomplish new treatments of previously untreatable disorders as well as improved treat ment of mundane problems. This brilliant form of light energy is many times more powerful than the energy of the sun yet can be focused microscopically to spot sizes as small as 30 microns. Lasers can be directed into seemingly inaccessible areas by mirrors or fiberoptic cables or can be directly applied into sensitive areas such as the retina without damage to intervening structures. There has been a rapid proliferation in the use of lasers in all surgical specialties. Starting with bold ideas and experiments of "thought leaders" in each specialty, the application of lasers has evolved into commonplace usage. Beginning with the era when laser presentations and publications were an oddity, now nearly all specialty areas have whole sections of meetings or journals devoted exclusively to laser usage. Laser specialty societies within a specialty have developed and residency training programs routinely instruct trainees in laser techniques. Basic science and clinical experimentation has supported laser knowledge. Laser usage has also become international. Newer wavelengths and accessories have added to the armamentarium of laser usage. Despite the rapid growth in laser interest, no single source exists to instruct the many new laser users in proper, safe, and effective use of this new modality."

Although many books deal with isolated problems of calcium disturbance in relation to cardiac and cerebral function, this is the first to focus specifically on calcium metabolism and cerebral ischemia. Internationally acknowledged experts present recent data and new concepts in an interdisciplinary approach to the subject. They examine basic information on the pathophysiology of cellular events, the damage caused by excitotoxic substances, and the effects of calcium antagonistic drugs as measured in experimental animals. These contributions may help lead to possible therapeutic interference for the prevention of calcium imbalance.

In the last ten years the pediatric neurosurgeon has witnessed a real revolution in the diagnosis and treatment of pediatric hydrocephalus, the most frequently encountered condition in everyday clinical practice. The evolution of MRI and the advent of neuroendoscopic surgery have resuscitated the interest in the classification, etiology and pathophysiology of hydrocephalus. The book offers an updated overview on the recent progress in this field, and a new approach to hydrocephalus: the reader will find in it a modern and new presentation of an old disease, where genetics, endoscopy, cost-effectiveness analyses and many other aspects of the various therapies are extensively discussed. The volume will be useful not only for neurosurgeons, but for all specialists interested in the various aspects of hydrocephalus: pediatricians, radiologists, endocrinologists, pathologists and geneticists.

As a neurologist and student of the microvasculature, I find great pleasure in introducing this treatise. Presented here is a view of brain pathophysiology and therapy from the perspective of the blood-brain barrier (BBB). Virtually every disease process that affects the brain-traumatic, neoplastic, infectious, inflammatory, toxic, metabolic, degenera tive, vascular, and epileptic-affects the BBB. Damage to this homeostatic system often leads to disruption of the composition and volume of brain fluid compartments, thereby contributing to neurologic symptoms and pathology. Furthermore, in disorders in which the integrity of the barrier is not breached, its normal restrictive nature may limit therapeu tic approaches. For example, the barrier appears to function normally in Parkinson dis ease, but its ability to compensate for striatal dopamine depletion is in part determined by the activity of transporters and enzymes operative in the brain microvasculature. of antibiotics, anticonvulsants, antineoplastic agents, and neurolep Similarly, the choice tics requires attention to these drugs' interaction with the BBB. Thus, the barrier inter faces with virtually all nervous system diseases and therapies. Future brain treatments with regulatory peptides, immune mediators, and gene components will require selective methods to deliver these agents to specific brain regions. The second volume of this text successfully provides a thorough review of BBB function and failure in a variety of clinical situations.

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 Krayenbuhl. Thus were established the principles of European co operation which have been born from the European spirit, flourished in the European Association, and have been associated throughout with this senes. The fact that the English language is now the international medium for communication at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contri butions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume for scrutiny and suggestions for revision. 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.

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.

Contrary to the neurological manifestations of arterial cerebral blood flow disturbances, respective conditions resulting fram obstruction of the cerebro-venous system are far less well understood. Hence, cerebral sinus vein thrombosis (CSVT) ranks prominently among the group of neglected diseases of the brain. This might be attributable (a) to the diagnostic difficulties of the disorder and (b) to the fact that CSVT is associated with a host of heterogeneous neurological symptoms which often are not specific for the underlying venous flow disorder. Another complicating aspect is that CSVT is a consequence of other diseases as disparate as focal infection, trauma, neoplasia, or a thrombosis disposition caused by oral contraceptive use. Although progress has been made in establishing the correct diagnosis of the syndrome, many problems remain as the discussions contained within this volume vividly demonstrate. The same is true for the present understanding of the pathophysiological basis of the disease, eg, concerning the cerebro-venous circulation, the hemodynamic and neuropathological consequences in particular. Part of these deficits may be attributed to a scarcity of solid experimental data due to the limited availability of animal models. However, relevant experimental models are required for an in-depth analysis of the pathophysiological mechanisms, eg, causing brain tissue damage in relationship with the topographical distribution of the venous flow obstruction and, most importantly, for the testing of specific methods of treatment.