Cerebral stroke is a common and widespread phenomenon affecting a large number of the human population worldwide. Various surgical methods have been developed for its treatment and the therapeutic results have steadily improved. This is a reassuring trend that promises further progress will be made in the future. This volume contains important contributions by leading clinicians and researchers in the field to the "International Symposium on Surgery for Cerebral Stroke" held in Sendai, Japan, May 24 - 27, 1987.

When I first proposed this book, one of the hopes was that it would be the stage upon which would be conducted a quiet, well reasoned discussion of the various techniques of stereotactic radio surgery. At that time, there was quite a bit of rancorous debate that tended to obscure the scientific and medical merits of each of the separate methods. At the present time, I am happy to report that the field of stereotactic radiosurgery is much less riven by such inappropriate posturing. The field has taken many steps towards maturity, both technically and medically. In the course of this mat uration process, there have been many grandiose plans and speeches made on behalf of stereotactic radiosurgery. Inevitably, the reality will not live up to the hype, but such is the natural course of devel opment in these sorts of matters. However, even though events may not match our hopes, we should keep in mind the words of Herbert Parker. Recognizing that new modalities for the treatment of cancer do not stand much chance of revolutionary success, nevertheless, he quite correctly pointed out that " . . . with any type of radiatiQn, the margin between success and failure is small. If the chance of success is a little greater . . . thi~ might well be classed as a great advance. " Mark H.

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.

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.

Intraoperative imaging technologies have taken an ever-increasing role in the daily practice of neurosurgeons and the increasing attention and interest necessitated international interaction and collaboration. The Intraoperative Imaging Society was formed in 2007. This book brings together highlights from the second meeting of the Intraoperative Imaging Society, which took place in Istanbul-Turkey from June 14 to 17, 2009. Included within the contents of the book is an overview of the emergence and development of the intraoperative imaging technology as well as a glimpse on where the technology is heading. This is followed by in detail coverage of intraoperative MRI technology and sections on intraoperative CT and ultrasonography. There are also sections on multimodality integration, intraoperative robotics and other intraoperative technologies. We believe that this book will provide an up-to date and comprehensive general overview of the current intraoperative imaging technology as well as detailed discussions on individual techniques and clinical results.

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.

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.

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.

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."

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."

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.

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."

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).

Because stroke is essentially a disease of the vessels and blood flow, the most fundamental aspects of ischemic blood flow in the brain are under investigation by researchers. Their work was the focus of the sixth in the series of Keio University International Symposia for Life Sciences and Medicine, held in Tokyo in 1999. Selected here are 55 papers from the symposium, covering the buffy coat (glycocalyx) of endothelial cells, the blood-brain barrier and permeability, gene expression, vascular reactivity, dysregulation, inflammatory deterioration, cortical spreading depression, edema, microvascular derangement, and pathology, in ten major sections. The book includes the thought-provoking discussions that followed the presentations, thus providing an invaluable source of up-to-date information not only for researchers investigating microcirculation but also for clinicians implementing the most effective treatment for stroke patients.

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."

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.

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.

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.

We are most pleased to present Volume 3 of Developmental-Behavioral Disorders: Selected Topics, designed to serve as a companion for standard reference textbooks that address cogent issues in developmental pedi atrics. Periodic publications such as Selected Topics and theme-related articles, as well as continuing education programs, attempt to supple ment in a timely fashion the rapidly changing knowledge base in devel opmental-behavioral pediatrics. These media are important as forums for enhancing the quality of clinical practice, teaching skills, and re search activities. The need is critical for periodically disseminating and updating information about issues in developmental medicine, in as much as this field of study continues to expand at a meteoric pace. During the past several decades, developmental medicine has been recognized as a defined subspecialty in pediatrics. The spectrum of problems encompassed by this discipline is relatively broad and at times clinically overwhelming. The ultimate goal of preventing delays, disor ders, and/or dysfunctions from becoming chronic handicapping condi tions has, by volume per se, created clinical dilemmas for pediatric health care providers. There are numerous facets of providing efficient and effective care, which in the field of developmental-behavioral pediatrics are often exaggerated impediments to the delivery of services by pri mary health care specialists, e. g., time, clinical skills, need for inter disciplinary management, medical-legal responsibilities, financial reim bursements. These issues, as well as clinical problems, are still very much part of the information base to be disseminated to concerned pro fessionals."

Advances in epilepsy in recent decades have allowed for improved algorithms for diagnosis and a common understanding of terminology with the development of the International Classifications of Seizures and the Epilepsies. Nevertheless, no common system exists for the estimation of epilepsy severity or its impact on quality of life. Therefore, epileptologists lack the ability to make quantitative assessments of individual patients for comparison of care or for meta-analyses in clinical trials. This book on the Quantitative Assessment of Epilepsy Care approaches this omission by addressing the potential application of clinimetrics within the framework of epilepsy treatment. Clinimetrics is a fast growing discipline concerned with the quantification of clinical symptoms with respect to decision making relating to diagnosis, treatment, and prognosis. These methods allow for the development and validation of clinical scoring systems. For example, the Glasgow Coma Scale is widely used. As a chronic disorder, epilepsy would benefit from clinimetric methodology to create uniformity and to allow for comparisons among evaluations. In addition, epileptologists have not yet developed assessments of health related quality of life to define the overall condition of the chronic epilepsy patient and various therapeutic endpoints. While clini metric tools are essential for research, they will also be useful in clinical practice for the care of individual patients by documenting status and changes over time. This treatise will provide critical analyses of whether existing rating scales and techniques are valid to use, and which types of scales and techniques require further development.