This book is the first of four books on the core principles of acute neurology. This book is a primer - and a great deal more - on how to clinically recognize acute brain injury and to treat its consequences. Acute brain injury often changes the dynamics of cerebral blood flow, cerebrospinal fluid mechanics and eventually intracranial pressure. And furthermore, acute brain and spine injury impacts on heart function, blood pressure control, breathing regulation and even gastric and bladder function. It is necessary to not only understand these fundamentals but also how certain measures could influence or correct these manifestations. Major concepts are illustrated to facilitate understanding. Each chapter concludes with a section that explains its relevance to clinical practice.The book truly combines basic neuroscience with practical know- how in an easy to read prose useful for both the novice and expert.

In any acute neurologic condition situations come up which generate questions about management. In a deteriorating patient there is a strain in decision making and many acute problems are hard calls. Handling Difficult Situations includes solutions for these reoccurring dilemmas. Each topic is carefully chosen and reflects clinical practice. The book addresses how to recognize treatable coma, how to judge the severity of traumatic brain and spine injury, and discusses how to recognize neurosurgical emergencies. Handling Difficult Situations also includes recognition and management of acute respiratory neuromuscular failure. A separate chapter discusses errors in CT scan evaluation of acute neurologic conditions.

* . . . . 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.

In this volume, world authorities on spinal surgery from the fields of Neurosurgery, Orthopaedic Surgery, and Neuroscience present current data on the basic science and clinical management of the unstable spine. Unique to this book: a frank presentation of controversies in the field.

Biomechanics of the Brain will present an introduction to brain anatomy for engineers and scientists. Experimental techniques such as brain imaging and brain tissue mechanical property measurement will be discussed, as well as computational methods for neuroimage analysis and modeling of brain deformations due to impacts and neurosurgical interventions. Brain trauma between the different sexes will be analyzed. Applications will include prevention and diagnosis of traumatic injuries, such as shaken baby syndrome, neurosurgical simulation and neurosurgical guidance, as well as brain structural disease modeling for diagnosis and prognosis. This book will be the first book on brain biomechanics. It will provide a comprehensive source of information on this important field for students, researchers, and medical professionals in the fields of computer-aided neurosurgery, head injury, and basic biomechanics.

Neurological applications of PET include using itto identify Alzheimer's Disease, including differentiating between other forms of Dementia, to show causes of seizures that were otherwise unclear, and to diagnose psychiatric disorders like Schizophrenia. Although other books on PET may have a chapter or section on neurological applications, this is the only comprehensive and up-to-date book on neurological PET. It reviews PET in neuroscience with particular emphasis on findings that indicate its potential for improving diagnosis and treatment in neurology and psychiatry. Improving the transfer of the huge scientific developments in brain PET into clinical carewill produce tangible human benefit. To this end, "NeuroPET" focuses on practical and potentially clinically relevant issues and identify solid ground as well as open questions. In addition, the book includes major chapters on the methodological background, including tracer physiology and kinetic modeling, and a comprehensive literature review."

More than 800 papers were presented by neurosurgeons from 66 countries during the 7th International Congress of Neurological Surgery, held in Munich on 12-18 July 1981. With the present scope and problems of neurosurgery as its theme, the congress achieved its aims in making possible the exchange and dissemination of new knowledge and ideas and in facilitating personal contact between neurosurgeons from aU parts of the world. Of such importance are the regional differences within our branch of science that we should spare no effort in acquainting ourselves with those neurosurgical problems which lie beyond the boundaries of our local horizons. From the vast number of papers the editor has selected those whose high scientific standard merits greater exposure than that given by the conference itself. I should like to thank the editor for his work and Springer-Verlag for their involvement in our disci pline. It is to be hoped that this book will find a worldwide audience, in accordance with the intentions of the World Federation of Neurosurgical Societies. Prof. Dr. K.-A. Bushe President of the Congress v Editor's Preface This is the first volume of a new series which aims to provide an overview of the state of the art of neurosurgery every four years. It will contain papers covering various fields of our specialty, selected from among those presented at each International Congress of Neurological Surgery."

Radiologists, orthopedic and neurological surgeons present the different minimally invasive methods. Peripheral nerve problems and problems concerning differential diagnosis in special situations such as between radicular and peripheral nerve trunk lesions are discussed, pinpointing the significance of different diagnostic tools. Minimally invasive techniques, utilized nowadays to minimize bone demolition, scarring and risk of recurrence are analyzed. Microdiscectomy is compared with the results of intradiscal techniques, and new methods are discussed facing problems such as epidural fibrotisation, microinstability, osteoporotic or neoplastic or posttraumatic vertebral lesions.

Neurological signs or symptoms are present in approximately 20% of all chil dren admitted to the hospital. These may be the reason for admission or may be part of preexisting and often unrelated problems. In ambulatory practice, acute neurological disease is not seen as frequently, but issues relating to normal and abnormal development are constantly being faced. For these reasons, familiarity with the progress of normal development and factors interfering with it, as well as knowledge of the major acute and chronic disorders of the nervous and neu romuscular systems, is important for any practitioner, specialist, or generalist who cares for children. The pathophysiology of neurological disorders in childhood is based on the same principles of the organization, structure, and function of the nervous sys tem as apply to adults. Two pitfalls are present for the student, however. First, the abnormalities are superimposed on a changing, developing brain, not a rather static, mature organ. The manifestations of the disease may vary, there fore, in seemingly unpredictable fashion depending on the rate of progression of the disorder and the rate and adequacy of the ongoing developmental changes in the nervous system. The second problem is the large number of unfa miliar conditions, many of which have no counterpart in adult neurology or medicine. These include developmental malformations, disorders specific to the neonatal period, and many hereditary and metabolic diseases."

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, established 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, successfully bring to the attention of physi cians within developing specialties what is occurring, but generally only in demonstration form without providing historical perspective, patho anatomical 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 and over this period, neurosurgeons have ob tained special training in pediatric neurosurgery and then dedicated them selves primarily to its practice. Centers, Chairs, and educational pro grams 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 ner vous system."

Epilepsy surgery is defined as any neurosurgical intervention whose pri- mary objective is to relieve medically intractable epilepsy (European Fed- eration of Neurological Societies Task Force 2000). The aim of epilepsy surgery is to reduce the number and intensity of seizures, minimise neuro- logical morbidity and antiepileptic drug (AED) toxicity, and improve quality of life. By definition, epilepsy surgery does not include normal surgical treatment of intracranial lesions where the primary goal is to di- agnose and possibly remove the pathological target, often an advancing tumour. In these patients, epileptic seizures are only one symptom of the lesion and will be treated concomitantly as part of the procedure. Temporal lobe epilepsy (TLE) is recognised as the most common type of refractory, focal epilepsy. In one third of all cases the neuronal systems responsible for the seizures that characterise this form of epilepsy fail to respond to currently available AEDs (Andermann F 2002). New imaging methods, especially magnetic resonance imaging (MRI), identify localising abnormalities in an increasing proportion of patients with intractable focal epilepsy. Consequently, the accuracy of the preoperative diagnostic pro- cedures has been significantly improved during the last decade; and suit- able candidates for surgery can be selected more reliably. Currently the main resources in most epilepsy surgery centres have been used to evaluate candidates for TLE surgery.

Detecting residual cognitive function in disorders of consciousness (M. R. COLEMAN, J. D. PICKARD).- Rationale for hypothalamus-deep brain stimulation in food intake disorders and obesity (N. TORRES, S. CHABARDEES, A. L. BENABID).- Gustatory and reward brain circuits in the control of food intake (A. J. OLIVEIRA-MAIA, C. D. ROBERTS, S. A. SIMON, M. A. L. NICOLELIS).- SEEG-guided RF-thermocoagulation of epileptic foci: A therapeutic alternative for drug-resistant non-operable partial epilepsies (M. GUENOT, J. ISNARD, H. CATENOIX, F. MAUGUIERE, M. SINDOU).- Child abuse - some aspects for neurosurgeons (B. MADEA, M. NOEKER, I. FRANKE.- Prophylactic antibiotics and anticonvulsants in neurosurgery (B. RATILAL, C. SAMPAIO).- The dural sheath of the optic nerve: descriptive anatomy and surgical applications (P. FRANCOIS, E. LESCANNE, S. VELUT) -Surgical indications and techniques for failed coiled aneurysms (C. RAFTOPOULOS; with the collaboration of G. VAZ).

The seventh annual multidisciplinary symposium on clinical oncology organised by the Royal College of Radiologists discussed the subject of malignant brain tumours. It was held in London in February 1985 and this volume collects together the edited texts of the papers which were presented at the meeting. Primary tumours of the central nervous system account for about 9070 of all malignant diseases but as much as 20% of all paediatric neoplasms. The prognosis ranges from excellent for some of the less aggressive tumours, through good for children's tumours such as medulloblastoma, to appalling for the high-grade adult astrocytomas. Improvements in pathological diagnosis and surgical and radiothera peutic techniques have led to considerable sequential improvements in outcome over those obtained in the past. In contrast the response to chemotherapy over the whole range of tumours remains disappoint ing, and clearly awaits new drugs and methods of delivery. The relative rarity of individual types of tumours, apart from the commoner high-grade adult astrocytomas, has made progress in terms of clinical trials difficult to organise. In spite of this much investigative work is in progress. The symposium, and the present volume, were designed to provide a comprehensive overview of the subject by experts, with an emphasis on the possible routes to future progress. The topics included aspects of pathology, imaging, diagno sis and treatment of both the common and uncommon primary tumours. It is hoped the papers will stimulate further interest and activity in this difficult area of clinical therapy and investigation."

This monograph analyses all aspects related to the etiopathogenesis, pathomorphology, diagnosis and treatment of lumbar disc herniation. It includes 24 chapters, over 500 illustrations, partly in colour, and 2800 bibliographic entries, going from the historical to the most recent ones. Five chapters are dedicated to biological and pathomorphologic aspects both of lumbar disc herniation and the conditions most often associated with herniation. The etiopathogenesis is analysed in the light of the most significant and recent studies. Five chapters deal with the clinical presentation and diagnostic tests in an extremely wide and detailed way. Large space is reserved to conservative management. The chapters on invasive treatments and on the results and complications of surgery define the advantages and limitations of the old and new percutaneous or surgical treatments. Two chapters are dedicated to surgical management of patients with spinal conditions associated with herniation, and two other deal with the surgical failure. This monograph is aimed at satisfying the requirements of both experts and young doctors. Some chapters are of particular interest to the spine specialist, whilst others are useful to the novice to acquire a general knowledge of the subject.

Filling a gap in the anatomical and ENT literature, the authors show the various approaches to the middle ear which allow safe surgical manipulations, such as through the tympanic membrane or the Eustachian tube.

Rehabilitation in Neurosurgery is not a new task but on Neurosurgical Rehabilitation in Munster, offering rather an indispensable part of neurological surgery the opportunity to visit various types of neurosurgical from the beginning, intended to avoid or to improve rehabilitation facilities. During this conference it be- diagnosable or impending damage to the CNS, and came apparent that neurorehabilitation had been ne- to prevent secondary and tertiary complications by glected by most of the neurosurgeons around the world adequate therapeutic measures. Rehabilitation should during the second half of the last century and it was agreed to improve on this situation by publishing the start right at the onset and site of the acute impact to the brain, spinal cord or peripheral nerves. Thanks results of their work as a special volume. to the tremendous progress in modern neurosurgery Selected papers from another two meetings (the regarding microsurgical techniques, instruments, so- 5th Annual Meeting of the Euroacademy of Multi- disciplinary Neurotraumatology, organised in con- phisticated technologies, multidisciplinary team ap- junction with the Meeting of the European Brain proaches, neuro-imaging, neuropharmacology, anti- Injury Society and France Traumatism Cranien, Paris, biotics, neuroanaesthesiology, and intensive care organized by the Congress President Jean Luc Truelle, treatment, more and more patients frequently survive on September 20-23, 2000; Workshop on Early Re- even life threatening lesions to the brain and spinal habilitation, Maribor, Chair Matej Lipovsek, March cord, however, at the expense of severe sensory, motor

This volume contains selected works from the 25th Anniversary of the International Conference on Intracranial Pressure (ICP) held in Williamsburg, Virginia. The theme of the meeting was Intracranial Pressure and Neuromonitoring and focused on all the current state of the art brain monitoring methodologies and their application to brain injury. The brain monitoring techniques covered a wide spectrum from neurochemical monitoring of the injured brain to specialized techniques for assessing shunt function in normal pressure hydrocephalus. It also includes the most recent advances in monitoring of the brain oxygen levels using electrodes or the less invasive Near Infrared Sprectroscopy devices. Controversial issues regarding the management of ICP and CPP or both are also addressed and there are several works dealing with this topic. Of particular interest is the group of papers describing diagnosis and outcome in normal pressure hydrocephalus. It is the first compilation of papers which covers all the latest brain monitoring studies in both ischemia, trauma and hydrocephalus. The manuscripts in this volume have been selected from over 300 abstracts submitted to this international symposium. The abstracts are also published in order to provide the most comprehensive view of the progress made in brain injury research.

Recovery of mimic function after facial nerve transection is poor: the successful regrowth of axotomized motoneurons to their targets is compromised by (i) poor axonal navigation and excessive collateral branching, (ii) abnormal exchange of nerve impulses between adjacent regrowing axons and (iii) insufficient synaptic input to facial motoneurons. As a result, axotomized motoneurons get hyperexcitable and unable to discharge. Since improvement of growth cone navigation and reduction of the ephaptic cross-talk between axons turn out be very difficult, the authorsa concentrated on the third detrimental component and proposed that an intensification of the trigeminal input to axotomized electrophysiologically silent facial motoneurons might improve specificity of reinnervation. To test the hypothesis they compared behavioral, electrophysiological and morphological parameters after single reconstructive surgery on the facial nerve with those obtained after identical facial nerve surgery, but combined with direct or indirect stimulation of the ipsilateral infraorbital (ION) nerve. The authors found that in all cases trigeminal stimulation was beneficial for the outcome by improving the quality of target reinnervation and recovery of vibrissal motor performance.

During the last decade, the effects of anaesthetics on cerebral blood flow, cerebral metabolic rate of oxygen and intracranial pressure have been studied experimentally and clinically. In this review studies of CBF and CMRO2 during craniotomy have been performed with the classical technique described by Kety and Schmidt. In chapter 1 general considerations concerning the effects of anaesthetics on cerebral blood flow and metabolism are reviewed. In chapters 2 and 3 the effects of inhalation agents and hypnotics on flow and metabolism are considered. Chapters 4 and 5 cover the effects of central analgetics, and neuromuscular blocking agents. In chapter 6 the effects of other drugs in common use in neuroanaesthetic practice are summarized. Chapter 7 considers the effects of drugs used for controlled hypotension. In chapter 8 the application of Kety's method in studies of CBF and metabolism is reviewed, the studies of cerebral circulation and metabolism during nine different techniques of anaesthesia for craniotomy are presented, and other studies of cerebral circulation during neuroanaesthesia are reviewed. In chapter 9 considerations concerning central and cerebral hemodynamics during anaesthesia in the sitting position are considered. This review is primarily addressed to anaesthetists, but it will also be of interest to those working within neurosurgery, neuroradiology and clinical neurophysiology.

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 present volume is based upon the invited review lectures delivered to the European Brain and Behaviour Society's Workshop on Recovery of Function Following Brain Damage held at Goldsmiths' College, University of London, in April 1991. Coming exactly ten years after the Society's ftrst meeting on this subject, held at Erasmus University, Rotterdam, a major objective of the Workshop was to review progress in the intervening years. This task was begun by Professor D. G. Stein in his opening presentation. Looking ahead to possible developments in recovery research in the next decade was the subject of Professor B. Kolb's closing lecture. The intervening presentations reviewed progress made in speciftc areas of recovery research. In addition to reviewing progress over the last decade we sought to achieve an additional objective in the way that the invited review lectures were organised. This was to bring together those doing basic research, usually animal research, and those whose of the lectures were "paired," research interests are more clinically orientated. Thus some one concentrating on the results of animal studies and one on clinical research findings.

From recent developments in the rapidly growing area of neuroscience it has become increasingly clear that a simplistic description of brain function as a broad collection of simple input-output relations is quite inadequate. Introspection already tells us that our motor behavior is guided by a complex interplay between many inputs from the outside world and from our internal "milieu," internal models of ourselves and the outside world, memory content, directed attention, volition, and so forth. Also, our motor activity normally involves more than a circumscribed group of muscles, even if we intend to move only one effector organ. For example, a reaching movement or a reorientation of a sensory organ almost invariably requires a pattern of preparatory or assisting activities in other parts of the body, like the ones that maintain the body's equilibrium. The present volume is a summary of the papers presented at the symposium "Sensory Interaction in Posture and Movement Control" that was held at Smolenice Castle near Bratislava, Slovakia, as a Satellite Symposium to the ENA Meeting 1994 in Vienna. The focus of this meeting was not only restricted to the "classical" sensory interactions such as between vestibular and visual signals, or between otolith and semicircular canal inputs. Rather, the symposium tried to consider also the interplay between perception and action, between reflexive and volitional motor acts as well as between sensory driven or self-initi ated motor acts and reafferent inputs."

This volume represents the proceedings of the 2nd annual symposium on the Brain Immune Axis and Substance Abuse held at the Breakers Hotel in Palm Beach, FL in June 1994. The history of productive studies concerning the relationship between the nervous and the immune systems is relatively recent. Studies on the effects of drugs of abuse on the immune system and on infections among individuals who abuse drugs are also of recent vintage. Only in the last decade have investigators begun to describe the role of drugs of abuse and their endogenous counterparts on the brain-immune axis. Thus, the involvement of the neuroendocrine system in the interactions of drugs of abuse and the immune system has only recently been appreciated. In addition, it has been recognized that direct neural inputs impact immune function. Given the complexity of these interactions, characterization of biologically significant phenomena and elucidation of their mechanisms of action often requires a multidisciplinary approach. This meeting, on which the chapters in this book are based, brought together scientists from an array of biomedical disciplines whose work is focused on the effects of drugs of abuse on the neuro-endocrine immune axis. The meeting was unique in focusing on the brain-immune axis from the viewpoint of drugs of abuse rather than either immunity itself or the brain itself. Presentations addressed the direct effects of drugs of abuse on various components of the immune system, as well as those mediated indirectly by the central nervous system and the neuroendocrine system.

Information is provided from the basic and clinical sciences on the mechanisms damaging the brain from trauma or ischemia. New aspects involve the endoplasmic reticulum, mitochondrial failure, pathobiology of axonal injury, molecular signals activating glial elements, or the emerging therapeutical role of neurotrophins. Experimental issues involve a better analysis of the ischemic penumbra, the salvagable tissue. Therapeutic contributions reach from the environmental influence to gene expression, including neuroprotection, such as hibernation - mother nature's experiment - or hypothermia which is reported to induce cell swelling. Treatment issues deal also with thrombolysis and combination therapies, or with the clearance of adverse blood components - LDL/fibrinogen - by a novel procedure using heparin. Other highlights are discussing the specificities of pediatric vs. adult brain trauma, or the evolving role of the Apolipoprotein-E e4 gene in severe head injury. An update is also provided on an online assessment of the patient management during the pre- and early hospital phase in Southern Bavaria. The empirical observation of neuroworsening is analyzed in further details, whether this is a specificity autonomously driving the posttraumatic course. Finally, the unsolved question why drug trials in severe head injury have failed so far in view of the promising evidence from the laboratory is subjected to an expert analysis.

Severe spondylolisthesis/spondyloptosis is still a controversial issue in spine surgery. This book takes an interdisciplinary approach and discusses the state of the art and defines therapeutic strategies. The contributing authors are well-known specialists in the field.