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."

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."

There is no question that the topic of this meeting in Seeheim, Germany, on intracranial and intralabyrinthine fluids is pertinent. This was the first international meeting at which these two closely-related topics were addressed together. Combining the clinical and research aspects of fluid and pressure regulation in the intracranial and the intralabyrint hine compartments as well as discussions on the clinical implications of abnormal fluid pressure was an excellent idea. The presentations and discussions of both the clinicians and basic scientists who participated proved that the concept of having such a combined focused gathering was both original and relevant. The two topics of the meeting in Seeheim have much in common. Maintaining both the intracranial pressure (lCP) and the intralabyrinthine pressure within normal limits is important for the normal functions of both the central nervous system and the ear. The intracranial space and the intralabyrinthine space are closed compartments that communicate with each other in an intricate manner. Deviations from normal intracranial pressure result in specific symptoms and signs. Medical problems related to elevated intracranial pressure vary from subtle to severe. Accumulated knowledge indicates that there are adverse effects from even relatively small elevations in ICP. Elevations in ICP may cause injuries to the brain and the ear. Abnormal pressure in the ear may cause abnormal function and injury. Maintaining the intracranial pressure within normal limits depends on a normally functioning pressure regulation."

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.

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 . . . . . . ."

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 contains selected contributions from the XIth Meeting of the European Society for Stereotactic and Functional Neurosurgery held in September 1994 in Antalyaffurkey. Most of the papers deal with the many therapeutic and technical advancements made in this field of neurosurgery. The emergence of new stereotactic methodologies such as frameless stereotaxy and other forms of neuronavigation have become an indispensable tool for all types of neurosurgical operations. An increasing number of young neurosurgeons takes an interest in the neurosurgical approaches to the treatment of movement disorders, chronic pain and epilepsy. This is a clear sign ofthe growing awareness of the long neglected fact that these neurosurgical treatments can be offered to large patient populations. Neurotransplantation as a novel treatment of Parkinson's disease has paved the way for the application of this technology for other indications. The pioneering work performed by the late Edward Hitchcock is reviewed here. There is a renewed interest in pallidotomy for dealing with certain forms of Parkinson's disease and certain aspects of this operation are discussed in another paper. Progress in the neurosurgical treatment of pain is dealt with by contributions on refined techniques of percutaneous cordotomy, DREZ operations and critical evaluations of spinal cord stimulation. A novel approach is a report on the experiences of treating cancer pain by intraspinal implantation of chromaffin cells. Several contributions cover the important issues of novel techniques for the study of neural dysfunction, peroperative monitoring with PET, microrecording, magneto-encephalography and other techniques.

These collected papers represent only a small part of the large amount of new work in the field of stereotaxy. The number of contributions to the Birmingham meeting was such that only selected papers, chosen as representative of advances in the field, could be printed. These papers present the most up to date accounts of major advances in stereotactic imaging and the renewed interest in the stereotactic treatment of movement disorders. Contents Section I. Stereotactic Imaging, Tumours and Haematomas Lipinski, H. G., Struppler, A., Birk, P.: Transformation Modes in Computerized Human Thalamic Brain Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 3 . . . Giunta, F., Marini, G., Bertossi, M.: Stereotactic Computer Graphic System with Brain Maps. . ., 7 Giorgi, c., Cerchiari, U., Broggi, G., Contardi, N., Birk, P., Struppler, A: An Intraoperative Interactive Method to Monitor Stereotactic Functional Procedures . . . . . . . . . . . . . ., . . . 10 Giorgi, c., Cerchiari, u., Broggi, G., Passerini, A.: 3-D Reconstruction of Cerebral Angiography in Stereotactic Neurosurgery . . . . . . . . . . . . . . . . . . . . . . .. . . . 13 . . Vandermeulen, D., Suetens, P., Gybels, J., Oosteriinck, A: Angiographic Localizer Ring for the BRW Stereotactic System . . . . . . . . . . . . . . . . . . . . . . . . . ., . . 15 . . . Uematsu, S., Rosenbaum, A. E., Erozan, Y. S., Gupta, P. K., Moses, H., Nauta, H. J., Rigsby, W. H., Wang, A, Weiderman, L., Kumar, A J.: Intraoperative CT Monitoring During Stereotactic Brain Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 18 . . .

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.

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.

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."

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.

This volume contains papers presented at the Fifth International Symposium on Intra cranial Pressure held on May 30-June 3,1982, in Tokyo, Japan. The Symposium has continued to grow since it began in 1972, and this year it was comprised 121 oral and 46 poster presentations. This considerable number was chosen from the more than 216 abstracts that were received, which made the selection process very difficult. We would like to thank the Program Committee for their efforts. One hundred and fifty-one of the manuscripts are printed here. The classic papers, short communications, and the presentations for the poster sessions here appear together under their appropriate topic heading. There were eleven sessions which spanned the most basic scientific descriptions of ICP dynamics to the most recent clinical advances and debate. Also included are the seven special seminars given by the invited speakers. These spe cial seminars were an innovation at this symposium as a means of reviewing the major aspects and history and of projecting the future directions of this expanding field. The organizers wish to thank the Advisory Committee for their guidance and focus, and to express their appreciation to everyone who contributed to the success of this meeting - to the Chairmen and Co-chairmen, to all of the members and participants, and not least of all to our executive staff who worked behind the scenes. We also wish to acknowledge our gratitude to Springer-Verlag for their technical aid and for their prompt publication of this volume."

The tumors of the brain similar to other pathological changes of that particular organ claim for a separate position in scientific medicine regarding biology, morphology, features of clinical manifestation, diagnostics and therapy. During the past years due to rapid progress in basic neurosciences and medical biotechnics the situation of the neuroclinician in front of brain tumors has been dramatically changed. The prerequisites for early and accurate diagnosis as well as for successful treatment also of malignant neoplasms have increased and remarkably improved. At the same time the information necessary for an appropriate pragmatic use of the available cognitive methods and therapeutic means increased along the same scale and is permanently being critically modified or changed due to fundamental new insights which come up in always shorter intervals. These facts necessitate the preparation of publications in which the state of the art is presented in possible completeness, systematic order and proper disposability for rational management and therapeutic strategies.

During the last few years stereotactic radiosurgery has become a partner of equal rank within the discipline of neurosurgery. Today it is regarded as being of the same importance as microsurgery and endovascular neurosurgery, branches which have also progressed rapidly in recent years. Breakthrough success, however, requires a combined effort of all partners involved. The editors have brought together leading experts in the fields of neurosurgery, neuroradiology, neurology, neuropathology, neuroanatomy, radiation oncology, and biophysics to discuss indications and therapeutic strategies in the treatment of arteriovenous malformations and intracranial tumors and to find a common basis for their future work.

Cervical Spine Research Society European Branch "The Cervical Spine Research Society is an organization of individuals interested in clinical and research problems of the cervical spine. Its purpose is for the exchange and development of ideas and philosophy regarding the diagnosis and treatment of cervical spine injury and disease. The com position of the membership should reflect the varying specialities and disciplines dealing with the cervical spine; biochemical, engineering, neurology, neurosurgery, radiology, orthopedic surgery and others," wrote J. William Fielding, New York City, one of the Society'S founding members. In 1984 the membership list contained 118 names. The overwhelming majority of members came from the United States, four from Canada and 9 Europeans, amongst them Mario Boni. He was the organizer, in con junction with the members of the Cervical Spine Research Society, of a splendid "International Meeting for the updating on pathology and surgery Preface VI of the cervical spine" held in Pavia (Italy) in May 1982. It was from this meeting that the idea of a European branch of the Society first originated, with the purpose of establishing multi-disciplinary meetings in Europe. The first meeting of the European branch was organized by A. Weidner in September 1984 in Osnabriick (Federal Republic of Germany). Mario Boni was elected president. He was not only the initiator but also the drivinglorce who tirelessly promoted the development of the European branch. Mario Boni's death in 1986 at the age of 64 was a great loss to us."

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."

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.

We have witnessed a remarkable development during the past 10 years in the development of extra-intracranial anastomosis to revascularize the brain. Initially, the intention was to create ameans of performing embolectomy in small corticaI arteries after cardiac surgery. Gradually a plan was conceived to form an extra-intracranial bypass(10) to treat inaccessible lesions of the carotid and vertebral arteries as weIl as tumors and giant aneurysms that involved these arteries. The basic techniques and principles of microvascular sur- gery, which had been refined over 30 years on peripheral ar- teries(1-7, 9) were applied in 1966 to the intracerebral arteries of dogs(4). The arterial patehing and suturing were successful, while extra-intracraniallong bypasses were a constant failure. This was attributed to the damage that was inevitably inflicted on the vasa vasorum of the autogenous graft during dissec- tion(9). This situation posed a dilemma until eventually the idea of Pool and Potts(8) was adopted and an anastomosis was performed on a dog between the superficiaI temporaI artery and a cortical branch. Because of the vesseIs' small size and the doubts regarding its capacity for improving the circulation, the procedure was performed with a certain amount of apprehen- sion. It was a pleasant surprise, therefore, to discover that it was possible to attain a high rate of patency. If the middle cerebral artery was us ed and was isolated from its carotid in- flow, an even higher rate was achieved.

This volume covers, in a logical sequence, the brain neuroscience which underpins current management of malignant brain tumours. Cellular and molecular studies are considered, as well as current concepts of histopathological classification and grading. The clinical manifestations and natural history of these tumours is set in context by a discussion of the pathophysiology of intracranial mass lesions. Special attention is given to low-grade and childhood tumours. The more common cerebral gliomas and cerebral metastases are also examined. Diagnostic imaging methods are described and the differential diagnosis of benign and malignant tumours is explored. The final chapters are devoted to conventional and innovative methods, along with the results, of treatment by surgery, radiation, chemotherapy and immunotherapy.

No special field of surgery dealing with the cranial nerves exists today. This is not surprising in view of the characteristics of this group of morphologically and topo graphically heterogenous nerves. Morphologically we must differentiate between central nerves (I, II and VIII) and the so-called peripheral nerves (nn. III to VII and IX to XII), in which post-lesion rgeneration is quite different. Anatomo-topographi cally we must consider an intracranial and an extracranial part of each cranial nerve. For practical reasons at operation, further subdivisions of the intracranial course of cranial nerves are to be distinguished in the anterior, middle and posterior cranial fossae as well as within the petrous bone. This underscores the extensive tasks awaiting surgeons operating in the ventral part of the brain and facial skull as well as in the more dorsal part of the skull and neck. This very wide field cannot be covered by a single surgical discipline alone. In our opinion, considerable progress has been made in surgery of the cranial nerves only in recent years. This may be explained by the increased mastery of microsurgical techniques by all surgeons in terested in the surgery of the base of the skull as well as with the initiation of more interdisciplinary consultation and jointly performed operations. Possibilities of fu ture development can be discerned in the text. The base of the skull separating the extra-and intracranial part of cranial nerves should not be a barrier but a connect ing link."