In July 2008, European and Japanese specialists in neurosurgery, neurology, interventional neuroradiology and neurointensive care joined together to discuss the latest developments in the management of cerebrovascular disorders at the 4th European Japanese Joint Conference on Stroke Surgery, held in Helsinki, Finland. This collection of papers from the meeting deal with aneurysm surgery and management of subarachnoid hemorrhage and stroke, arterial dissection, intracranial arteriovenous malformations and fistulas, and microneurosurgical bypass and revascularization techniques.

Memory is essential for the retention of learning. In the presence of memory deficits, new learning is impaired and performance of previously learned habits deteriorates. What is the nature of memory? Where does it reside in the brain? What biological events are associated with the formation and retrieval of memory? These questions are explored in the first chapter of this volume. The answers are not final, but we have learned a great deal about memory processes during the past few decades. Memory is influenced by most of the pathological processes that influ ence the brain such as infection, trauma, cerebrovascular disorders, and met abolic and degenerative diseases. The nature and course of memory impairment are unique for each of the disorders and are fairly distinguishable. More than fifty conditions are known to cause dementia, which now affects several million Americans. In Alzheimer's disease, memory disorder predominates for two to three years before other intellectual functions are affected. Many neurological diseases, such as Huntington's disease, Friedreich's ataxia, and multiple sclerosis, are associated with progressive memory deficits. Forgetting is a problem that becomes progressively worse with age. Most individuals in their forties begin to experience some difficulty in quick recall of past events. By age sixty definite changes are evident in the process of registration, storage, and recall of memory. At this age the material that is to be remembered is processed more slowly, stored less firmly, and poorly recalled."

The human nervous system-that most complex organization of energy and matter-has yielded a few glimmers of understanding of its operational me chanics during the last two decades. These have mostly been at the biochemical level of structure and function. Throughout history, as one of the mysteries of nature begins to yield some insights into its function, it has been beneficial to look at it from different points of view. We have developed a volume on movement disorders that is primarily directed toward the biochemical understanding of these disorders and their treatment. Each disorder is presented from several points of view. Although this approach leads to some repetition, it is our aim that the final outcome be a more complete understanding. Much has been written about movement: the beauty of the prima ballerina, the strength of the olympic athlete, and the agility of the surgeon. Seldom do we stop to look beneath the surface-the coordination of muscle groups, the finely tuned balance allowing rapid response in either direction, the individual muscle fibers coordinated to maximize strength and agility, and the nerve fibers connecting muscle with nerve centers. Some of these communicate sensory input of position to the centers while others communicate directions of move ment to muscles. We encourage our readers to be constantly alert to the possibility of in creasing their understanding of other nervous system functions, including thought disorder, through an understanding of movement, either in general principle or by specific chemical interaction."

Primary reconstructive surgery is assuming increasing importance in the management of fractures of the spine. Analysis of the injury and thus surgical decision-making are greatly facilitated by the diagnostic power of CT and MRI. This volume provides a systemic introduction to the interpretation of CT and MRI images of injuries to the spinal column and the spinal cord, with special emphasis on the assessment or residual stability. Since survey X-rays remain the indispensable first step in radiodiagnosis, the typical appearances of spinal injuries on conventional films are also shown. This will help the reader interpret the CT and MRI images and also reflects the procedure in radiologic practice. The books classification of spinal fractures, together with the attempt to conclude how the injury happened by analyzing the damage caused, paves the way for individually oriented therapy.

Progress in traumatology of the vertebral spine has been restrained for a long time by two hindering factors. The first obstacle is presented by the differences in approach and a conflict of competences. The neurosurgeons, considering only the spinal chord, have confined themselves to indications for laminectomy, an insufficient and usually ineffective intervention. The orthopedic surgeons, on the other hand, obsessed by the fear of medullary lesions, have long hesitated to apply the fundamental rules for the treatment of fractures, namely precise reduction followed by strict immobilization, thus depriving themselves of the efficacy of radiculomedul lar decompression and of the protection this procedure affords to these structures when they are themselves involved in the trauma. Taking these facts into account, together with the rather poor results of laminectomy, the specialists have wisely and successfully recommended that one should abstain from treating the initial lesion, but rather attenuate the damage by appropiate nursing care and adequate reeducation. The second hindering factor was the insufficient knowledge of the extreme complexity of the anatomic lesions. This explains the orthopedists' relative caution; one only treats well what one knows well. More precise analysis of the lesions, not only of the bones but also of the joints, i. e., the osteofibrous involvement, is mainly based on strict radiologic semiology, which is rendered difficult because these structures are simultaneously affected. We are greatly indebted to Dr. DOSCH, radiologist at our Center, for having untertaken this difficult task, using all available conventional radiologic techniques."

Recent radiologic procedures in bone and joints, some of which eliminate the need for surgery are exposed, including: trephine biopsies of the thoracic and lumbar spine, sacro-iliac joints, peripheral bones synovial membrane and soft tissues, using either fluoroscopic echographic or CT guidance - chemonucleolysis - vascular embolization of skeletal tumors and management of vertebral hemangiomas - selective steroid injection in a broad spectrum of diseases including vertebral facet syndrom, cervicobrachial nerve root pain, rotator cuff calcium deposits, bone cysts. This unique volume supplies the reader with complete information regarding the performance of all these techniques.

The Third Advanced Seminar in Neurosurgical Research was held in the Palazzo Pisani Moretta, Venice, Italy from 30th April to 1st May, 1987 and was devoted to "Neuroendocrinological Aspects of Neurosurgery." The general aim of these advanced seminars is to bring together European Neurosurgeons interested or involved in research work, 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 may be suitable for future research. A special effort is made to identify younger neurosurgeons 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. The topic of Neuroendocrinology was chosen because clinically it is an area of controversy that should be amenable to application of new techniques, including molecular biology. There is a tendency on the part of Endocrinologists not to appreciate always that disturbances seen by Neurosurgeons may be different and need special attention. Inevitably there has been a little delay in publication of the manuscripts but these have been updated appropriately.

The second common meeting of the European Section and the Cervical Spine Research Society took place in Marseille (France) from June 12 to 15, 1988 and was organized by Rene Louis. More than 130 specialists from every part of Europe, from America and Asia participated, representing, among others, the fields of Orthopedics, Neurosurgery, Traumatology, Neurology, Anatomy, Rheumatology and Radiology. This meeting again was convincing proof of the growing interest which exists in Europe in research into injuries and diseases of the cervical spine. The main topics of this meeting were the subluxation of the lower cervical spine (chapter 1) and the infectious diseases of the cervical spine (chapter 2). Chapters 3 and 4 of this volume deal with degenerative lesions and the upper cervical spine. In chapter 5 experimental reports are presented, so that a good synopsis is provided of our present state of knowledge of diseases of the cervical spine. The European Section of the Cervical Spine Research Society was founded by Mario Boni in 1984, who unfortunately died in 1986 and was proclaimed Honory President of the European Section. There is a European meeting every summer and one every three years with our colleagues from the United States of America, Canada and Japan organized in Europe. The first combined meeting was organized by Pierre Kehr in Strasbourg (France) in 1985 and the presented papers were published in Cervical Spine I (Springer, Wien-New York, 1987).

Every so often a gathering of minds and experience occurs that results in an all encompassing overview in depth of such a vast subject as Cerebro-Vascular Malformations, as occurred in Verona in June 1992 and which warrants publication. Professors Da Pian and Pasqualin deserve high compliment and it is a measure of the respect in which they are held that virtually all those most knowledgeable around the world attended, presented their work and thoughts and contributed to intense discussion. Ljunggren's opening historical survey set the stage and must be the most comprehensive yet published. Subarachnoid hemorrhage from aneurysm rupture still constitutes, I dare say, the most difficult problem for neurosurgeons, in relief of the brain injury and arterial reaction and the technical perfection of aneurysm obliteration, even for small, as well as large and giant sacs. Very large high flow A VMs can be as demanding too. The bulk of the conference was devoted to subarachnoid hemorrhage, aneurysms and A VMs which were discussed under about 14 headings each. But vein of Galen malformations, dural A VMs, cavernous angiomas and venous angiomas (renamed developmental venous anomalies) came under scrutiny, not always with consensus. Trends are perceptible such as fibrinolysis of subarachnoid clot, non surgery for Galenic and dural malforma tions, the benignity of venous angioma, but there is still much variation in approach, pharmacologically, technically and with such as the evolving endovascular and radiosurgical stories, used alone or in conjunction."

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."

This book contains the papers delivered at the Fourth International Symposium on Intracranial Pressure, held at Williamsburg, Virginia, USA, June 10-14, 1979. Divided into 12 sessions, they reflect the most recent developments in areas such as head injuries, pressure volume studies, cerebrovascular complications, intracranial hemor rhage, brain edema, systemic factors and infectious processes, data recording and analysis, CSF formation and absorption, hydroce phalus, clinical aspects of ICP monitoring, anesthesia and intra cranial pressure, treatment with barbiturates and steroids, and os motherapy. The book concludes with a summary of the present state-of-the-art in the field as a whole by Dr. Langfitt. There were two innovations at this Symposium. The first of these was poster sessions, the second, breakfast seminars. This volume contains all papers read plus all those presented as posters, and for this reason contains more pages than the three previous volumes. The organizers wish to thank the Advisory Committee for the work done in paper selection and focus of the Conference. Appreciation is also given to the Chairmen and Co-chairmen of the sessions for the preparation of summary statements. Manuscript preparation was performed by Ms. Lucille Browne, and gratitude is expressed to her. The next Symposium, the Fifth International Conference on ICP, will be held in Japan in 1982. We also wish to acknowledge the technical help of Springer-Verlag and their celerity in producing this volume. The Editors VII Contents Session I. Head Injury Chairman: D. P. BECKER; Co-chairman: I. PAPO 3 Summary . . . . . . . . . . . .."

Great progress has been made in the understanding and prevention of secondary brain damage from acute cerebral disorders, such as trauma and ischemia. Advances may be concerned in particular with better organization and logistics of preclinical emergency care, including rapid arrival of well-trained medical staff on the scene of an accident and of transportation to a competent hospital. Nevertheless, it is a safe assumption that development of secondary brain damage from both intra- and extracranial causes still represents a major factor for the final outcome in severe head injury. Thus, exchanges of experiences and information between various disciplines involved with this important clinical problem - trauma still assumes the number one position as a cause of morbidity and mortality up to an age of 45 years - may provide a basis for in-depth analysis of remaining problems as well as of methods of their solution. This exactly is the purpose of the present publication on concepts and findings pertinent for the general subject of secondary brain damage from various experimental as well as clinical viewpoints. An internationally high-ranking group of experts has been contributing to this collection of reviews on cerebral trauma and ischemia and its adverse sequelae, including cerebral exploration by most modern technologies, such as NMR spectroscopy or PET scanning, among others.

The last ten years has witnessed a resurgence of interest in stereotactic surgery although this has been mainly in the field of the comparatively simple stereotactic biopsy of intracranial tumours. There is also evidence of a returning interest in functional neurosurgery other than pain which has always sustained high levels of endeavour. The present work comprises selected papers from a much larger group of interesting and important communications to the European Society for Stereotactic and Functional Neurosurgery. They represent modern views on a wide variety of stereotactic surgical topics from internationally acclaimed experts in this field. The neurosurgeon who has little or no acquaintance with this fruitful sub-specialty will be surprised to find very broad applications of the technique which is gradually replacing many con ventional neurosurgical procedures. This is particularly evident in the papers on tumours but there is also a section on the treatment of vascular disease which marks an extension of neurosurgical practice. The Society has always regarded technical advances as important and some of the most recent devel opments appear in this book. Finally, an exciting new development of neural transplantation marks the beginning of what may be an important part of neurological surgery in the future."

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).

Despite a worldwide reduction in its incidence, stroke remains one of the most common diseases generally and the most important cause of premature and persistent disability in the industrialized countries. The most frequent cause of stroke is a localized disturbance of cerebral circulation, i.e., cerebral ischemia. Less common are spon taneous intracerebral and subarachnoid hemorrhages and sinus ve nous thromboses. The introduction of new diagnostic procedures such as cranial computed tomography, magnetic resonance imaging, digi tal subtraction radiologic techniques, and various ultrasound tech niques has led to impressive advances in the diagnosis of stroke. Through the planned application of these techniques, it is even possible to identify the pathogenetic mechanisms underlying focal cerebral ischemia in humans. However, these diagnostic advances have made the gap between diagnostic accuracy and therapeutic implications even greater than before. This fact can be easily explained. In the past, therapeutic studies had to be based on the symptoms and temporal aspects of stroke; it was impossible for early investigations to consider the various pathogeneses of cerebral ischemia. Inevitably, stroke patients were treated as suffering from a uniform disease.

The dawn of neurosurgery can be traced back to the first description preserved in the Edwin Smith papyrus' (3000 Be) which dealt with head and spinal injury. In the course of 5000 years, since the first record in Egypt, advances in lifestyle and technology have brought about our modern civilized society. However, as a result of civilization, currently the total number of severe head injuries worldwide is believed to exceed 10000000 and the number of severe spinal injuries is believed to be more than 75 000 each year. This means that central nervous system injury is not only the oldest topic in neurosurgery, but that it is also of critical importance in modern life. Taking these problems into consideration, the International Neurotraumatology Committee was organized in 1965 as an affiliated Committee of the World Federation of Neurosurgical Societies. The first scientific meeting was convened by the Committee in Marseilles in 1970. Nine further meetings were subsequently held, in Europe, Africa, and South America. The meeting was first named "International Conference on Recent Advances in Neurotrauma tology" (ICRAN) by Professor Phillip Harris, when the scientific meeting was held in Edinburgh in 1982. The tenth meeting, (ICRAN 1992), the first one in Asia, was held at Karuizawa, Japan, from September 23rd to 26th, 1992."

During the past ten years, technology has been progressing at a rapid pace in the field of medical science, and there have been great improvements in the basic understanding, diagnosis, and treatment of hydrocephalus. The present volume contains the proceedings of the International Symposium on "Hydrocephalus" that was held in Kobe, Japan, from November 12-14, 1990. The purpose of the symposium was to highlight the recent advances in this field and to provide a unique opportunity for exchange of basic and clinical knowledge among experts in this field. During the symposium, 84 papers were presented by 240 contributors from 14 countries. This volume is a compre hensive description of the current knowledge in this area, and it may help to define what is known and to find new strategies to understand the patho genesis, pathophysiology, diagnosis, and treatment of the hydrocephalic process. The editors take great pleasure in expressing their thanks to the contributors for their participation and cooperation, and to Springer Verlag for personal and technical assistance in publishing the proceedings. We sincerely hope that this volume will contribute to improving the treat ment for hydrocephalus. August 1991 The Editors V Contents Preface.......................................................... V List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . XV . . . . . . . . . . . . . Special Exhibition 1 Hydrocephalus: Historical Review H. Sato and S. Matsumoto. . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . . . . . . ."

This monograph presents a comprehensive review of the clinical experience in surgical repair of cranial defects which the author has gained during a period of over ten years. Particular problems of patients undergoing cranioplasty, such as neurological impairments, EEG changes, variations of intracranial pressure, and sinking skin flap syndrome are described and discussed. The author presents convincing evidence of the importance of cranioplasty in improving the quality of life of patients with large and disfiguring cranial defects. Unfortunately, cranioplasty still ameliorates only to a minimal extent the general condition in patients suffering of major cerebral lesions. I am convinced that this volume will serve the purpose it was designed for : that it will be a most helpful introduction into the problems related to reconstructive surgery. Basel, August 1984 Otmar Gratzl Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 A. History of Cranioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 B. Clinical Aspects of Cranial Bone Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 I. Origin of Cranial Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1. Acquired Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2. Congenital Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 3. Demographic and Other Characteristics of Patients . . . . . . . . . . . . . . . . . 9 II. Neurological and Psychic Changes Before and After Cranioplasty . . . . . . . 11 1. Classification of Neurological Deficits and of the Skin Flap Types . . . . . 13 2. The "Sinking Skin Flap Syndrome" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3. The Influence of Cranioplasty Upon Neurological and Psychic Changes 17 III. Electroencephalographic (EEG) Changes in Patients with Cranial Defects 21 1. EEG Recordings and Casuistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2. Evaluation of EEG Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 IV. Scintigraphy Findings in Patients with Cranial Bone Defects . . . . . . . . . . . . 26 1. Casuistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2. Results and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The Leitmotiv of the Second Convention of the Academia Eurasiana Neurochirurgica was "Cerebrum convalescit" - literally "the brain recovers." The focus of the meeting was on plasticity of the central nervous system, one of the most decisive factors in recovery and readaption after cerebral lesions. Distinguished experts from the fields of neurosurgery, neurology, neurophysiology, anatomy, pathology, oncology, and pharmacology discussed the following topics: - Molecular and cellular basis of plasticity - Regeneration and growth in the CNS - Self-organization of neuronal network - Brain oedema - a reparatory process? - Growth factors and carcinogenesis

From its discovery in 1929 by Hans Berger until the late 1960s, when sensory visual and auditory evoked potentials were dis covered and became popular, the EEG was the most important method of neurophysiological examination. W-ith the advent of computer technology in the 1980s, it became possible to plot the potential fields of the EEG onto models of the scalp. This plot ting of information as neuroimages followed the structural and functional techniques of Cf, MRI, PET and SPECf. The success of this method, which began in the early 1980s, has led to the brain mapping of EEGs and EPs being increasingly used for di agnosistic purposes in neurology, psychiatry and psychopharma cology. The pioneers of this method believed in it and were commit ted to its success. However, many traditionalists felt that it gave no new information and so regarded the method with scepticism. Some found both the coloured maps and the mapping technique misleading, which led to unnecessary conflict between mappers and their chromophobic oponents. Emotions have run so high that some professional bodies have justifiably adopted guidelines and warned of the misuse of the method."

In his Preface, Dr. Fox has quoted Cannon Professor Fox has undertaken the monumental task of compiling the available data on intracra- and Rosenblueth in questioning where to stop nial arterial aneurysms. The magnitude and ex- the record. One can only document progress tent of the undertaking attest to the tremen- to date-and certainly the advances in this field dous amount of information which has are noteworthy-and then make some cau- accumulated in the past few decades and to tious predictions for the future. They have cor- the accelerated pace at which the field has ex- rectly made note that the overall morbidity panded, particularly since the end of World and mortality of these aneurysm patients re- War II. mains unacceptably high, largely as a result of Our heritage can be traced to many sources, the secondary complications of the subarach- among whom should be mentioned such nota- noid hemorrhage itself. More attention should bles as Willis, Quincke, Blackall, Moniz, Dott, be directed in the future to the recognition of Dandy, Hounsfield, and others. The modern era those patients with unruptured aneurysms and includes a number of investigators and clini- those with minimal bleeds. Hopefully infor- cians, some of whom have contributed to this mation will be forthcoming as to which indi- magnificent tome. The bibliography of over viduals are at risk because of some unusual con- 4000 references represents the increasing in- genital, metabolic, or acquired defect.

The human personality is inextricably bound up with, among other things, the function of the central nervous system. Diseases and malfunctions of the brain, head injuries and neurosurgical operations can all result in permanently altered behaviour patterns. This interrelation between brain and behaviour is most clearly demonstrated in cases involving functional neurosurgery and severe traumatic lesions. Despite the fact that this interrelation represents an everyday challenge to the neurosurgeon, it is a question which receives less attention than it deserves in neurosurgical meetings. Given the scope and complexity of this topic, it is not possible to cover every aspect of it here: hence, discussion is limited to the impact on personality of injuries, language, epilepsy and psychosurgery. However, before considering the medical aspects, it was deemed necessary to try and arrive at a definition of "personality." This question was discussed by a number of philosophers representing various perspectives. Their diversity of viewpoints and conceptions greatly enriched the discussions.

There are two important reasons for publishing this new series entitled "Advances and Technical Standards in Neurosurgery" 1. the lack of any or ganized common European postgraduate training system for young neurosurgeons and 2. the language barriers, which impede the exchange of neurosurgical findings in Europe more than in other parts of the world. 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 the Editors 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 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 postgraduate train ing. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons."

The publication of the Vth International Symposium 1995 on "Mechanisms of Secondary Brain Damage" in Mauls/ltaly is a collection of focused reviews reaching from novel molecular- and cell biological findings to aspects of clinical management in head injury and cerebral ischemia. A specific purpose of these series of meetings introduced in 1984 is for an exchange on problems of mutual interest by international high ranking experts from the basic sciences and related clinical disciplines, such as intensive care medicine, neurology, or neurosurgery. The present volume covers three major areas: (a) Molecular and cell biological mechanisms including inflammation (b) Novel findings on mechanisms and treatment in cerebral ischemia (c) Secondary processes in head injury, regeneration and treatment Molecular-and cell biology is currently attracting attention towards activation of genomic processes associated with the demise of cells referred to as "programmed cell death" and "apoptosis" which, actually, might be distinguished from each other. Thus, the phenomenon of delayed neuronal death in selectively vulnerable brain areas following brief interruption of blood flow is scrutinized as to the contribution of the activation of suicide genes. The physiological role of such a response, among others, is removal of surplus neurons during ontogenesis of the brain. Yet, evidence is accumulating that similar mechanisms playa role in cerebral ischemia, probably also trauma, where nerve-and other cells demonstrate features of apoptosis. Observations on protection of neurons by administration of protein synthesis inhibitors in cerebral ischemia provide more direct support.

"Modem Neurosurgery of Meningiomas and Pituitary Adenomas" presents the state-of-the-art of neurosurgery for these two types of tumors. Following a classification of the pituitary adenomas according to pathology, molecular biological factors are presented and their effects evaluated as these aspects deepen our understanding of the growth and further expansion of these tumors. The diagnosis is made not only by a study of the hormonal status, but also by neuroradiology. A number of authors have devoted their efforts to the special problem groups such as the elderly patients and those with huge pituitary adenomas. Particular emphasis is of course placed on the surgical treatment, including transcranial and transphenoidal neurosurgery, but the use of medical treatment and irradiation must be discussed as well. The treatment of meningiomas has also been influenced by the molecular biology of hormone and growth factors. Therefore it is accorded extensive space in this volume. The prognostic significance of nuclear DNA content is discussed. Recent research with new diagnostic methods such as somatostatin scintigraphy, PET studies end progesterone receptor in tumor fragment spheroids is presented here. The treatment of these tumors, however, depends largely on their localization. For the neurosurgeon, the surgical treatment of meningiomas involving the cavernous sinus, meningiomas of the ventral Foramen of Monroe, meningiomas of the cerebello pontine angle and of the optic sheath is presented by prominent experienced leaders in this field."