Pituitary adenomas account for 10-15% of all intracranial tumors and they frequently impair fertility. The development of medical and surgical therapy for such tumors has turned pregnancy into a reality for women harboring pituitary adenomas. However, gestation risks for both mother and fetus are still of concern for endocrinologists, gynecologists and pediatricians. This book intends to update knowledge on this topic, mainly regarding fertility restoration as well as gestational and post gestational management of patients with pituitary tumors.

..". I would recommend this book for an in-depth analysis of the lumbar spine and its degenerative states ... extremely beneficial for the resident early in trainings as he or she attempts to correlate the complex anatomy of the lumbosacral region with associated pathological states ... Journal of Neurosurgery"

1 2 3 O. D. Wiestler , U. Schlege1 , andJ. Schramm lInstitut flir Neuropathologie, Universitatskliniken Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany 2Neurologische Universitatsklinik, Sigmund-Freud-Str. 25, 53127 Bonn, Germany 3Neurochirurgische Universitatsklinik, Sigmund-Freud-Str. 25,53127 Bonn, Germany In contrast to various other neoplastic disorders, there has still been no dramatic progress in the treatment of gliomas. Modem microsurgical and imaging techniques have made more tumors surgically accessible and have allowed a more extensive surgical resection. However, these new developments have not improved the clinical outcome. Recently, molecular biological studies on genes and genetic loci affected in tumors of the nervous system have yielded significant new insights into pathoge- netic machanisms. Many neuro-oncologists are therefore looking forward to transla- ting molecular genetic findings into novel diagnostic and therapeutic strategies for the management of these devastating neoplasms. We have produced this volume with the intention of highlighting major developments in both molecular and clinical neuro-oncology and of stimulating the communication and cooperation between these two fields. Two major families of growth-controlling genes have emerged from the past decade of intense research on the molecular genetics of tumors: oncogenes and tumor suppressor genes. Oncogenes are characterized by their potential to stimulate the growth of susceptible cells whereas tumor suppressor genes share a growth-inhibi- ting property. A stringently controlled interplay between these two regulatory me- chanisms is required to maintain a stable composition of tissues.

The pioneering work by Pierre Janny and Nils Lundberg added a new tool to the investigative armamentarium of the neurosurgeon: continuous monitor ing of intracranial pressure (ICP). A small group of basic and clinical sci entists recognized the importance of this method and in 1972 an International Symposium was organized by Mario Brock in Hannover, Germany. The workers "of the first hour" had high expectations and thought that the problem of intracranial hypertension could finally be dealt with. The Symposium con tinued to grow during subsequent meetings in Lund (1974), Groningen (1976) and Williamsburg (1979). However, the advent of the modern imaging tech niques of CT and MRI have dramatically changed the scene in clinical neurology and neurosurgery. These new methods as well as other monitoring techniques have put ICP in its proper place as just one of the many aspects, albeit an important one, in the management of patients with intracranial space-occupying lesions. The symposia in Tokyo (1982), Glasgow (1985) and Ann Arbor (1988) confirmed the steady interest in ICP recording, both as a research tool and as a clinical method. and yielded many new developments in the field of ICP. This book comprises the proceedings of the Eighth International Symposium on Intracranial Pressure that was held in Rotterdam, The Netherlands, from June 16th to 20th, 1991."

The aim of this volume is to provide an illustrated overview of basic knowledge relevant to neurosurgery for students specializing in neurosurgery, operating room personnel, and neurologists seeking to inform themselves about surgical principles and applications. The major aspects of neurosurgery are presented in a clear, easy-to-follow outline form. Summaries are included of: neuroanatomy; neurologic syndromes, functional diseases, and traumas treatable through neurosurgery; physiologic and pathologic events occurring during neurosurgery. The principles of neurologic examination and diagnosis as well as supplementary diagnostic modalities are discussed from a neurosurgical perspective. The book can thus be used as an aid for quick bedside diagnosis and patient management and as a handy reference companion.

The 4th Advanced Seminar in Neurosurgical Research was held on May 17th-18th, 1989 in the Abbey of Praglia, a XIIth century Benedictine Monastery, near Padua, Italy, and was devoted to "Neurosurgical Aspects of Epilepsy." The general aim of these Advanced Seminars is to bring together European Neurosurgeons interested or involved in research, either clinically, experimentally or both, in a given field in order to achieve in-depth informal discussions not possible in the more conventional large congress. In particular, these Advanced Seminars seek to provide high level teaching by experienced basic scientists, to provide "state of the art" assessment of the subject and to highlight areas of controversy that might be suitable for future research. A special effort is made to identify younger Neurosurgeons, partly through the auspices of the European Directory of Neurosurgical Research, who have a particular interest in the subject under discussion, not all of whom will have immediate access to the most advanced, modern technology. Surgical treatment of epilepsy is an expanding area of endeavour and an expertise that remains underutilized in many countries. The programme for this Seminar was designed to paint the broad background, moving from basic membrane electrophysiology through to cost benefit analysis and rehabilitation. The perspectives of neu ropathology, neurology, neuroradiology, nuclear medicine, neuropsychology, neurophysiology and the drug in dustry are all included."

Agreed standards and guidelines are the heart and soul of improving the differing training systems and to harmonize neurosurgical training in the European countries. Such standards and guidelines have been laid down in the European Training Charter of the European Union of Medical Specialists and recently novellated. This book, written by experienced neurosurgeons, offers all those concerned with neurosurgical training - trainers and trainees - practical advice to implement the above mentioned standards and recommendations. It has been written as a manual: "How to do it." It describes the tasks of a chairman (programme director), the tasks of the teaching staff, the organisation of a training curriculum, a rotation plan or a morbidity and mortality conference, the periodic progress evaluation, the course of an external audit and many more important topics. It contains a lot of practical tips, check lists and useful examples. Well educated young colleagues offer "safe neurosurgery" to our patients.

It is amazing to discover how little importance has been attached to narrow lumbar canal syndromes up to now. Though H. VERBIEST gave a very accurate description in 1949, the neurologist's and neurosurgeon's preoccupations were mainly focused on discal pathology, disregarding the problem of an exclusively bony origin in canalar stenosis. A. WACKENHEIM and E. BABIN have the merit of becoming aware of the impor tance and originality of this problem; they organized in the beautiful surround ings of the Bischenberg near Strasbourg, a postgraduate course, in which the most eminent European specialists in this field participated. I am very honored to have been asked to write the introduction to this mono graphy, which contains all the studies reported and commented on during this meeting. Before considering the problem from the various radiologic points of view, it is in my opinion indispensable to define the term "stenosis." We could not do so more accurately than by assuming the definition proposed by A. WACKENHEIM and E. BABIN and unanimously confirmed by all those who attented the session."

A state-of-the-art presentation of intraoperative neuro- physiologic monitoring by specialists from well-known international medical centers.

The spinal cord has a characteristic structure and functions that are distinct from those of the brain. Its functions are tremendously important since it modulates the peripheral sensory inputs to the dorsal horn, and it gives rise to the ascending pathways transmitting peripheral afferent inputs to the brain, and conveys the descending pathways from the brain both to the lower motor neurons, the final common pathway, and to dorsal horn sensory neurons. In spite of these vital functions, the spinal cord constitutes only a small percent age of the mass of the human central nervous system and is located far from the skin surface, which has obstructed the recording of its electrical activity. Recently, however, important advances have been made in several recording techniques, including epidural recording or averaging methods, allowing both sensory and motor evoked spinal cord potentials in man to be recorded. This volume is based on the papers presented at the Fourth International Symposium on Spinal Cord Monitoring and Electrodiagnosis. Each of these international symposia has brought together many of the specialists involved in this research, with an important increase in the number of participants since the first symposium was held in Toyko in 1981. At the past symposia several attempts were made to standardize data, techniques, and clinical applications and to integrate the new findings into patient care."

The development of magnetic resonance imaging (MRI) will deep ly change the relationship between neuroanatomy and the neuro logical sciences, particularly neuroradiology. Presentation of nor mal or abnormal brain structures is sometimes more precise in MRI sections than in brain or spinal-cord sections under macro scopic examination. It is our conviction that a better exchange be tween neuroanatomy and neuroradiology will improve knowledge of the brain. This international meeting held in Marseille, 26-27 September 1986 (under the Presidency of G. Lazorthes and G. Di Chiro in collaboration with M. Habib, secretary of redaction for the Congress and its publication) would like to contribute to this field. Marseilles, January 1988 A. Gouaze G. Salamon Table of Contents Introduction G. Lazorthes 1 External References of the Bicommissural Plane U. Bergva71, C. Rumeau, Y. Van Bunnen, J. M. Corbaz, and M. Morel. . . . . . . . . . . . . . . . . . . . . . . 2 Identification of Cortical Sulci and Gyri Using Magnetic Resonance Imaging: a Preliminary Study C. Rumeau, A. Gouaze, G. Salamon, J. LafJont, F. Gelbert, H. Einseidel, M. Jiddane, P. Farnarier, M. Habib, and S. Perot . 11 The Hippocampal Formation and Related Structures of the Limbic Lobe: Anatomic - Magnetic Resonance Correlation T. P. Naidich, D. L. Daniels, V. M. Haughton, A. Williams, P. Pech, K. Pojunas, and E. Palacios. . . . . . . . . . . . . 32 Brain Stem and Cerebellum: Normal and Pathological Anatomy C. M. Strother and C. Raybaud . . . . . . . . . . . . . . . . . 65 Magnetic Resonance Imaging of the Eyes and the Optic Pathways J. C. Tamraz, M. T. Iba Zizen, and E. A. Cabanis . . . . . . ."

Lumbar spine or back pain is one of the most important problems in orthopedics and neurosurgery today. Two key ways of treating this malady, lumbar fusion and stabilization, are critically discussed in the forty-three papers in this volume. They represent the best of the contributions to the 5th ICLFS, carefully selected and edited to give a good overview of recent knowledge and the state of the art.

Lesions of the brain stem and related disorders of autonomous regulation systems have been the "Leitmotiv" of the scientific work in the Neurosurgical Department of the Giessen University under the leadership of the late Professor Hans Werner Pia. Some of the results have already been published in supplement volumes of Acta Neurochirurgica. The first one of these was Vol. 4 with the monograph written by H. W. Pia on "Die Schadigungen des Hirnstammes bei den raumfordernden Prozessen des Gehirns." Vol. 19 deals with central disorders of temperature regulation, written by G. Lausberg, followed by Vol. 20 with R. Lorenz's monograph on the effects of intracranial space-occupying lesions on blood pressure and heart rate. Shortly before his death Hans Werner Pia had asked me to combine and publish in this series of supplement volumes of Acta Neurochirurgica another five papers by his co-workers, also related to brain stem lesions and also to cerebral blood flow and CSF dynamics. The result is this volume which contains work dealing with the CT -findings of cerebral mass displacements and their clinical correlations (Sch6nmayr), with other lesions of the brain stem (Laun), with the blink reflex and acoustic evoked potentials in brain stem lesions (Klug and Csecsei), with blood flow in brain structures during increased ICP (Zierski) and with the description of a mathematical model for analysis and simulation of the haemodynamics of intracranial CSF (Hoffmann).

Although in the last few years more experience in the field of epilepsy surgery with amygdalo-hippocampectomies was gained in several hos- pitals, a detailed microanatomical and microsurgical description meet- ing the requirements of the modern neurosurgeon has not been achieved so far. Recently the allocortex - the so-called "limbic system" - has doubtlessly received more attention, as can be gathered from the recently published monography by Duvernoy, which however only considers anatomical points of view. Lately not only epilepsies but also tumorsurgical operations on the border between temporal lobe and basal ganglia can be - thanks to modern MR-examinations - carried out more exactly. Here the tumor-conditioned deformations of the temporo-medial area and its connections with the adjacent basal gang- lia as well as their blood supply are of great importance. Using conven- tional techniques the postoperative morbidity was especially high until recently. The author has at the suggestion of his teacher G. M. Ya argil approached the problem first of all morphologically by developing his own techniques of brain dissection. After some developmental and topographic-anatomical descriptions he has described the vessel-supply by using injection-preparations. Particular aspects of A. chorioidea ant. with her lateral, medial and Tractus opticus penetrating perforat- ing arteries to the basal ganglia and Capsula into have never been described in such a convincing manner before. It is of great importance in the operative removal of the amygdalo- hippocampal area to realize that it is not sufficient to preserve the A.

This volume represents the collected papers presented at the Third Triennial Symposium of the International Basal Ganglia society (IBAGS) held at Capo Boi, Italy, June 10-13, 1989. About 300 members of the society and participants attended the symposium which was held in a delightful environment conducive to the formal and informal exchange of scientific thought. The interdisciplinary nature of the symposium was unique in its coverage of the neurosciences from molecular biology to clinical and behavioural studies. The 80 papers collected here reflect the wide spectrum and the depth of studies on virtually all aspects of the basal ganglia. Unfortunately, this book does not capture the cordial and congenial atmosphere which has characterized this, and all prior symposia of the Society. Any cooperative endeavour of this kind requires a tremendous effort and dedication, usually by a small number of individuals. The Society is especially pleased to acknowledge the support and encouragement of the "Italian Ministry of university and Scientific Research" and the "Italian National. Research Council". In addition the society received financial support from numerous Foundations and corporations, which are listed separately under acknowledgements. Finally the Editors are pleased that Plenum Press, which has published the two previous symposia, has accepted this program for publication. It is our hope that vast scientific efforts reflected in these pages will be widely disseminated and further encourage every kind of research related to the basal ganglia.

Das vorliegende Buch enth{lt die Beitr{ge eines internatio- nalen Symposiumszum Thema "Stimulierte Hirndurchblutung." Vorgestellt werden zun{chst neue Erkenntnisse zur Regulation der Hinrdurchblutung. Im 2. Abschnitt kommen verschiedene Methoden zur Messung der Hirndurchblutung zur Sprache, die sowohl unter experimentellen als auch unter klinischen Be- dingungengetestet wurden. Es folgt ein Abschnitt, der ver- schiedene M-glichkeiten zur Stimulation der Hirndurchblutung aufzeigt. Im letzten Abschnitt wird aufdie Bedeutung der stimulierten Hirndurchblutungsmessung zur Bestimmung der ce- rebrovascul{ren Reservekapazit{ten hingewiesen. Dieser Para- meter hat nach den vorliegenden Untersuchungen klinisch- praktische Bedeutung, beispielsweise f}r die Indikations- stellung bei cerebrovascul{ren Eingriffen zur Isch{mie-Pro- phylaxe.

This atlas offers a collection of EEG spectral analyses and their corresponding conventional recordings under anes thesio10gical procedures. The EEGs presented here were re corded on general surgical and gynecological patients during the last few years. Premedication, induction and maintenance of anesthesia, recovery the immediate postoperative period, and intensive care are covered. Techniques for operating the necessary equipment and artefacts relevant to the routine clinical use of EEG are briefly outlined. Typical examples of characteristic EEGs are presented at the beginning of each chapter, followed by illustrations of deviations from the norm showing the great variety of anesthesiologically induced changes of cerebral function. The description of each EEG course is assessed in relation to clinical parameters. Sometimes no satisfactory interpreta tion can be made, because many physiological and patho physiological causes of alterations in cerebral function are unknown. Time and again it proves impossible to estimate wether deviations from the norm have their origin in cerebral changes or are secondary to extracerebra1 disturbances. The atlas comprises a complete survey in itself, but it can also be seen as a supplement to the book The Electroenceph alogram in Anesthesia by I. Pich1mayr, U. Lips, and H. Kunkel (Springer, 1983), in which detailed lists of references are quoted that are omitted here."

The region of the skull base was long considered a surgical barrier because of its complex anatomy. With few exceptions, the region immediately beyond the dura or bony skull base constituted a "no man's land" for the surgeon working from the other direction. A major reason for this was the high morbidity associated with operative procedures in that area using traditional dissection techniques. This situation changed with the advent of the operating microscope. Used initially by ear, nose and throat specialists for resective and reconstructive surgery of the petrous bone and parana sal sinuses, the operating microscope was later introduced in other areas, and neurosurgeons began using it in the mid-1960s. With technical equality thus established, the groundwork was laid for taking a new, systematic, and interdisciplinary approach to surgical problems of the skull base. Intensive and systematic cooperation between ear, nose and throat surgeons and neurologic surgeons had its origins in the departments of the University of Mainz bindly supported by our chairmen Prof. Dr. Dr. hc Kurt Schiirmann (Department of Neurosurgery) and Prof. Dr. W. Kley (Depart ment of Ear, Nose and Throat Diseases, Head and Neck Surgery). The experience gained from this cooperation was taught in workshops held in Hannover from 1979 to 1986, acquiring a broader interdisciplinary base through the participation of specialists from the fields of anatomy, patholo gy, neuroradiology, ophthalmology, and maxillofacial surgery.

At the present time several techniques are available for studying quantitatively global and regional blood flow and metabolism of the human brain. How ever, many scientists working in the clinical and research field who would like to use these tools for their investigations may be less familiar with the indi cations and limitations of the individual methods. The rapid development of both modern imaging techniques and new tracers may have led to some con fusion in answering the question as to which method is appropriate to solve the diagnostic problem of an individuum with brain disease. Scepticism and ignorance as to the methods to be used as tools in differential diagnosis of brain disorders may have prevented their widespread introduction into clinical practice. Thus, the significance of circulatory and metabolic parameters involved in the majority of diseases of the central nervous system may have been overlooked. The contributions compiled in this book describe in detail the individual techniques, outline their indications and limitations and deal in particular with newer methods such as the atraumatic 133Xe technique, stable xenon tomogra phy, three-dimensional techniques such as 133Xe single photon emission tomog raphy and N-isopropyl-P23-iodoamphetamine. Positron emission tomography studies provide information on function and metabolism, particularly that of oxygen and glucose, in regional brain areas of interest. Nuclear magnetic reso nance may be a promising method for studying metabolic parameters; however, accurate circulation measurements can not be performed at present."

Technological improvements in neurosurgery are disussed. The use of surgical lasers, ultrasound aspirators, bipolar coagulator and operative microscopes for surgery of deep-seated neoplasms and vascular malformations is discussed. Intraoperative monitoring, chronotherapy, chronic neurostimulation and stereotactic interstitial irradiation are covered and indications for interventional neuroradiology are reviewed.

It is a great honor and pleasure for cerebral infarction have been carried me to have Springer-Verlag publish out. Dr. Yoshimoto hoped that the this volume entitled "Treatment of results of research done in our depart Cerebral Infarction." I am much in ment over the last sixteen years con debted to my colleagues for my success cerning cerebral infarction could be in publishing this book. published. Moved by his enthusiasm, I have engaged in clinical work in my colleagues took their share in writ the field of neurosurgery for these few ing each article. I suggested to them decades and I have performed more that this volume should cover primarily than 5,000 major operations of intra the results of our own research, but that cranial surgery. Throughout this time, at the same time it should also include it has been my privilege to conduct a 2- the results of related work done by neurosurgical experts throughout the hour-morning research seminar in our department every Wednesday and to world. Therefore, I hope that this book supervise a great deal of research. At will interest many investigators who these seminars my fellow research have devoted themselves to research in workers and I have exchanged many the field of neuroscience. ideas about the study of neurosurgery My colleagues acknowledge that and we have designed many animal our research has been stimulated and experiments."

Since the introduction of electrosurgery the techniques of surgery on the nervous system have passed through further improvements (bipolar coagulation, microscope), even if the procedure was not substantially modified. Today, laser represents a new "discipline," as it offers a new way of performing all basic maneuvers (dissection, demolition, hemostasis, vessel sutures). Furthermore, laser offers the possibility of a special maneuver, namely reduction of the volume of a tumoral mass through vaporization. Its application is not restricted to traditional neurosurgery but extends also to stereotactic and vascular neurosurgery. Laser surgery has also influenced the anesthesiologic techniques. At the same time new instrumentation has been introduced: CUSA ultrasonic aspiration, echotomography, and Doppler flowmeter. I have had the chance to utilize these new technologies all at a time and have come to the conclusion that we are facing the dawn of a new methodology which has already shown its validity and lack of inconveniences, and whose object is to increase the precision of neurological surgery. The technological development is still going on, and some improvements are to be foreseen. Laser scalpel is splitting the initial laser surgery into NO TOUCH and TOUCH surgery with laser. As new instrumentarium will be developed, a variable and tunable beam will become available. For example, in a few years Free Electron Laser will further add to the progress in this field."

During the last decade a multitude of studies concerning the dynamic changes in cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), and intracranial pressure (ICP) in the acute phase after head injury have been published. These studies have been supplemented with studies of cerebral autoregulation, CO2 reactivity and barbiturate reactivity. Other investigations include studies of cerebrospinal fluid pH, bicarbonate, lactate and pyruvate. In this book experimental and clinical studies of the dynamic changes in CBF, CMRO2, CO2 reactivity and barbiturate reactivity are reviewed. The author's own clinical studies of the dynamic changes in CBF and cerebral metabolism are summarized and discussed, and the therapeutical implication as regards the use of artificial hyperventilation, sedation with barbiturate and mannitol treatment are discussed.

Neurosurgery o/the Future: Computers and Robots in Clinical Neurosurgical Practice and in Training - a Philosophical Journey into the Future Many present day neurosurgeons believe that they already obtain good results in operative surgery with the benefit of the operating microscope and other aids which have become available in the last three decades and that the introduction of computers and robots to the operating theatre is superfluous. However, it is clear from analogy with the function of the airline pilot, another profession where there are great demands on manual skill and on spatial awareness, that these devices do have much to offer neurosurgery. Classical neurosurgery, in the time of Cushing, Dandy and Scarff, was based on a three dimensional picture of the patient's brain formed in the surgeon's mind and often illustrated in elegant drawings. Such pictures were based on neuroradiological studies by pneumoencephalography, ventriculography or by angiography. Generally these stud ies showed the presence and position of a lesion by displacement of normal brain structures and the picture was built up by interference. This was then converted by the experienced neurosurgeon into a plan for the craniotomy site and the trajectory of the surgical approach. Once the brain was exposed further pre-operative information was obtained by visual inspection and by palpation with the brain needle. These classical forms ofneuroradiology have largely been superseded by computerised tomography and by magnetic resonance imaging."

More than 40 years ago British and German neurosurgeons met in Berlin and Breslau to exchange their experiences, to strengthen their friendly bonds, and to enjoy the attractions of both cities and their surroundings. In 1960 a joint meeting of the Dutch and German societies took place in Rotterdam by invitation of the Nederlandse Vereniging van Neurochirurgen. All who attended this meeting thankfully remember the great hospitality during these unforgettable days. In 1970, by courtesy of the Society of British Neurological Surgeons, German neurosurgeons had the pleasure to become acquainted with the great tradition of British sciences at one of the most famous places during the meeting in Cambridge. These impressions were deepened by visits to other famous sources of British scientific tradition during the European Congress in Oxford in 1975. The critical distance sometimes necessary towards our own discipline is implicit in the major themes of this meeting. Complications following shunting procedures for hydrocephalus have been discussed on the basis of the results of a cooperative study of some German neurosurgical departments. The second main topic was problems and diagnostic errors in computer tomography. The papers presented contain critical considerations about the findings obtained by this method, as well as on its possibilities and limitations. German neurosurgeons felt deeply indebted to their British and Dutch colleagues and wanted to return their kindness at this joint meeting in Berlin. We hope that all participants will retain pleasant memories of the days in this city.