The human skull has many functions. The largest component of the skull, the neurocranium, protects and insulates the brain. It comprises the dome-shaped vault or calvaria, obviously a protective structure, and the more complex cranial base, which gives the vault a massive foundation and also houses the organs of hearing, balance, and smell. The facial skeleton, or splanchnocranium, encloses the upper airway and the mouth. Chewing, the cQ-ordinated action ofthe jaws and teeth, is a function of the facial skeleton. The orbits, formed from both calvarial and facial bones, house the eyes and their accessory muscles. The'skull also provides skeletal support for the muscles which affect speech and facial expression. It is largely by these that people communicate and display their emotions. Personality is judged on speech and on facial appearances, by conscious or subconscious aesthetic comparisons with cultural ideas-and prejudices. So the shape of the skull has, or can have, profound emotional significance.

The management of cerebral aneurysms is still sub- are being carried out on unruptured cerebral aneu- ject of controversy in spite of recent dramatic advances rysms and presentation of such new clinical experi- in surgical techniques and neuro-intensive care. Cur- ences allowed intensive discussions in order to find out rently there are three main topics in this field with to- updated and proper ways to focus the treatment. The tally different aspects: second day provided updated information on neuro- critical care aspects as well as endovascular and surgi- 1) management of unruptured cerebral aneurysms as cal treatment modalities as performed in daily practice a preventive medicine and in Zurich and Japan. Round table discussions encour- 2) neurocritical management of severe subarachnoid aged an interactive communication between the par- hemorrhage (SAH) after rupture and ticipants and faculty. 3) advances in the microsurgical and endovascular techniques regarding the management of cerebral In this volume we publish the proceedings of this aneurysms. Swiss-Japanese Joint Conference on Cerebral Aneur- ysm. Our gratitude is extended to the many contrib- In order to create an opportunity to discuss these top- utors and to all those who participated in the confer- ics, the Swiss-Japanese Joint Conference on Cerebral ence. Publication of the proceedings is supported by Aneurysm Management was held in Zurich, Switzer- Health Sciences Research Grants for Medical Frontier land, from May 5 to 7, 2001; Prof. Dr. Y. Yonekawa, Strategy Research regarding multi-center studies on Zurich and Prof. Dr. Y.

Evidence-based Clinical Practice (EBCP) is the conscientious, explicit, and judicious use of current best external evidence in making decisions about the care of individual patients. In neurology, practice has shifted from a rich, descriptive discipline to one of increasingly diagnostic and therapeutic interventions. Providing a comprehensive review of the current best evidence, Neurology: An Evidence-Based Approach presents this type of evidence in a concise, user-friendly and easily accessible manner. The three co-editors of this important volume are linked in their passion for evidence-based clinical practice in the clinical neurological sciences, connected to a common historical origin at the University of Western Ontario (UWO), London, Ontario Canada and influenced directly by Evidence-Based Medicine teachings of McMaster University, Hamilton, Ontario Cananda. The book is organized in three sections: Basics of Evidence-Based Clinical Practice, with an introduction to the topic, a chapter on the evolution of the hierarchy of evidence, and another chapter on guidelines for rating the quality of evidence and grading the strength of recommendation. The second section, Neurological Diseases, provides an illuminating overview of evidence-based care in ten of the most common areas in neurologic practice. The final, third section provides an outstanding roadmap for teaching evidence-based neurology with a chapter on the Evidence-Based Curriculum. A superb contribution to the literature, Neurology: An Evidence-Based Approach offers a well designed, well written, practical reference for all providers and researchers interested in the evidence-based practice of neurology.

An International Conference on "Neurosurgical Training and Reserach" was held in Munich from October 6 - 9, 1996, under the auspices of the EANS, and organized by H.-J. Reulen and H.-J. Steiger. Experts from different countries and neurosurgical organizations have collected information on the present status of resident training in neurosurgery and the mechanisms involved with the training. Various aspects, the recruitment process, the criteria used for selection, the contents and structure of a program, the continuous quality control, exposition to the art of research, fellowships and subspeciality training, etc. have been covered. The present book contains this material and thus provides a unique and comprehensive source of information on the complex of modern neurosurgical training. " ... The beauty of this work is that it puts in one place the many varied aspects of a neurosurgical training program that one needs to be aware of ... should be required reading for the faculty of any academic training program as well as for others who may have a misconception of what residency training is ... an excellent book for any program director or active faculty member. It should be required reading for all faculty members before the next round of resident interviews ..." Neurosurgery "... well edited, published to a high standard and will naturally be of interest to those specifically involved in the areas of selection and training ... a useful text for aspirants to surgical training posts ..." British Journal of Neurosurgery

During the past three decades, the cerebral vasculature and its role in blood-brain transport has been an increasingly active area of investigation and learning, particularly from an anatomical and physiological point of view. However, much less is known at the molecular and cellular level about the blood-brain barrier especially regarding the macromolecules responsible for transport, the roles played by vascular wall components (endothelial cell, pericyte, smooth muscle, basement membrane), and the mechanisms regulating brain vascular-specific protein expression and their molecular alterations during development and disease. Fundamental questions still unanswered include: What are the molecular constituents of brain endothelial cell tight junctions? What are the membrane proteins responsible for transport of specific substrates? What are the molecular signals that cause glucose transporter gene expression to be 20 to 100 times greater in brain endothelial cells in vivo than in vitro? What roles do pericytes, smooth muscle cells and basement membrane have in establishing or maintaining blood-brain transport characteristics? Are brain vascular transport systems responsible for edema following injury? Are transporter systems regulated via receptor-mediated events? Do hormones or neuromodulators regulate transporter expression? What is the molecular mechanism by which plasma proteins enter the extravascular space? Are transporters asymmetrically distributed between the luminal and abluminal endothelial cell membranes? Can prodrugs or pharmacologic agents be designed as substrate analogs and be delivered to the central nervous system via existing transporters or receptors? Can new and beneficial transporters be introduced into the brain vasculature?

Soon after neurosurgery had advanced past the stage of that older neurosurgeons will consider their cra removing lesions on the surface of the brain, it became niotomies quite adequate for the relief of many neu apparent that subcortical diseased tissue could not be rological disorders that Professor Kandel shows so excised safely by the usual surgical techniques because clearly to be amenable to stereotactic intervention, of the risk of damaging overlying normal structures. there are many lesions that undoubtedly can be reached Various means of reaching deep-seated lesions were more easily and with less risk to life and limb by ster devised, most of which attempted to approach the eotactic than by open procedures. pathological tissue through "silent areas" of the brain. This book is not just a description of operative However, these operations often resulted in serious procedures, although it does give clear accounts of neurological deficits. Spiegel and Wycis's modifica surgical techniques. It presents the postoperative histo tion of the Horsley-Clarke apparatus to reach targets ries of patients who have been cured or markedly re deep in the human brain introduced a new approach to lieved of longstanding afflictions; these persons have subcortical surgery. True, as Professor Edward Kandel been followed for 10 to 15 or more years, so that the relates, Russian surgeons had pioneered in the field, results may be considered more or less permanent."

Understanding the structure and function of the blood-brain barrier (BBB) and recogniz ing its clinical relevance require a concert of scientific disciplines applied from a view point of integrative physiology rather than from only molecular or analytical approaches. It is this broad scope that is emphasized in this book. In my opinion, four original contributions define the field as it exists today. The first, a monograph by Broman,1 entitled The Permeability of the Cerebrospinal Vessels in Normal and Pathological Conditions, was the model for many subsequent clinical and 3 experimental studies on BBB pathology. Second, experiments by Davson, summarized in his book entitled Physiology of the Ocular and Cerebrospinal Fluids, indicated that passive entry of nonelectrolytes into brain from blood is governed largely by their lipid 4 solubility. This research supported the original suggestion by Gesell and Hertzman that cerebral membranes have the semipermeability properties of cell membranes. The modem era of the barrier was introduced with the 1965 paper by Crone,2 entitled "Facilitated transfer of glucose from blood to brain tissue. " This paper identified stereospecific, facilitated transport of glucose as part of a system of regulatory barrier properties at a time when only a barrier to passive diffusion had been contemplated. Finally, the 1967 paper by Reese and Kamovsky, 11 entitled "Fine structural localization of a blood-brain barrier to exogenous peroxidase," sited the barrier at the continuous layer of cerebrovascular endothelial cells, which are connected by tight junctions.

The XIV International Symposium on Brain Edema and Brain Tissue Injury took place in Warsaw, Poland, on 11-14 June 2008. Two prominent members of the International Society for Brain Edema: Dr. Igor Klatzo and Dr. Julien Hoff have passed away after the last 2005 Symposium in Ann Arbor, USA. Dr. Igor Klatzo was actually the founder of the Society, and the Advisory Board decided to commemorate Dr. Igor Klatzo by introducing a lecture named after him to be given at the Symposium. Prof. Dr. Hans-Jurgen Reulen has been honored to give the frst Igor Klatzo lecture entitled "Bulk Flow and Diffusion revisited, and Clinical Applications". This volume contains 65 out of the 104 papers presented at the Symposium as lectures or posters. The topics of the Symposium were similar to those discussed at the previous ones. Many discussions focused on clinical work especially diagnosis, subarachnoid hemorrhage, hydrocephalus, and traumatic brain injury. Diagnosis and therapy, including surgical methods, have also been verifed. Much attention was drawn to the application of decompressive craniectomy in the treatment of posttr- matic intracranial hypertension. The pathomechanisms of brain edema and tissue injury studied in experimental models have been also presented.

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series of Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. This series was first discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathers of the series being Jean Brihaye, Bernard Pertuiset, Fritz Loew and Hugo Krayenbiihl. Thus were established the principles of European co operation which have been born from the European spirit, flourished in the European Association, and have throughout been associated with this series. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by spe cialists in the given fields and constitute the first part of each volume."

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series devoted to Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume. In the second part of each volume, we publish detailed descriptions of standard operative procedures, furnished by experienced clinicians; in these articles the authors describe the techniques they employ and explain the advantages, difficulties and risks involved in the various procedures. This part is intended primarily to assist young neurosurgeons in their post graduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons."

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

For centuries the great minds of medical science puzzled over the importance of the cerebrospinal fluid. As far back as Hippocrates, it was thought that this "phlegm" that flooded the intracranial contents had pathological significance. However, not until the late 1800s, when Quincke introduced and popularized lumbar puncture, did physicians take an interest in the study of this fluid in relation to clinical illness. Since then a variety of techniques for obtaining cerebrospinal fluid from various sites have developed, and the relationship of cerebrospinal fluid to a variety of disease processes has received considerable study. In this volume, we have attempted to assemble reviews of some of these important developments during the past century. Chapter 1 contains a historical review of key investigations that helped shape our concepts of cerebrospinal fluid from the earliest recorded description by the author of the Edwin Smith Surgical Papyrus in the seventeenth century B. C. to contemporaries such as Kabat, Glusman, and Knaub, who introduced quantitative determinations of cerebrospinal fluid gamma globulin levels. In Chapter 2 there is a description of our current understanding of the anatomical compartment for the cerebrospinal fluid and the physiology of its formation, circulation, and absorption. Dr. Richard Leech in Chapter 3 contributes a comprehensive description of the disorders associated with excessive quanti ties of cerebrospinal fluid-commonly referred to as hydrocephalus. A variety of techniques for properly collecting and evaluating cerebrospinal fluid are detailed in Chapter 4."

Spinal Fusion: Science and Technique puts the experience of top professionals into your own hands. Drs. Jerome M. Cotler and Howard B. Cotler and their impressive group of contributors, including researchers, educators, and clinicians, have joined together to bring you this concise, comprehensive reference. Sections relating to history, basic science, surgical indications and techniques, complications, postoperative management, as well as a philosophical chapter on the future of spine surgery are presented. With the help of over 250 superb illustrations, Spinal Fusion: Science and Technique contains the most current and authoritative compilation of knowledge relating to surgical management of disorders of the spine. It is destined to become an essential tool in your working library.

It is estimated that the functionally significant body of knowledge for a given medical specialty changes radically every 8 years. New special ties and "sub-specialization" are occurring at approximately an equal rate. Historically, established journals have not been able either to absorb this increase in publishable material or to extend their reader ship to the new specialists. International and national meetings, sympo sia and seminars, workshops, and newsletters successfully bring to the attention of physicians within developing specialties wh at is occur ring, but generally only in demonstration form without providing historical perspective, pathoanatomical correlates, or extensive discus sion. Page and time limitations oblige the authors to present only the essence of their material. Pediatric neurosurgery is an example of a specialty that has devel oped during the past 15 years. Over this period neurosurgeons have obtained special training in pediatric neurosurgery and then dedicated themselves primarily to its practice. Centers, Chairs, and educational programs have been established as groups of neurosurgeons in different countries throughout the world organized themselves respectively into national and international societies for pediatric neurosurgery. These events were both preceded and followed by specialized courses, national and international journals, and ever-increasing clinical and invest igative studies into all aspects of surgically treatable diseases of the child's nervous system."

Posttraumatic cerebral contusions, lacerations and hematomas in the past could often only be suspected by clinical symptomatology and be visualized by angiography in a restricted manner, but they are now diag nosed with precision through CT and MRI; they remain in the limelight in our daily management of severe head injuries. Stalhammar's longlasting research in biomechanics is he re condensed in a concise review of the current knowledge in this field, thus providing the basis for our understanding of the parenchymal cerebral posttraumatic lesions. The neuropathological investigations and findings remain fundamental to the clinical features, and in this text there is the advantage that they were carried out and interpreted by a very experienced neurasurgeon, Ion Oprescu, who most regretfully died before the completion of this volume. The special morphological and clinical investigations by Nakamura, concerning diffuse brain injury, contribute to our necessary diagnosis and treatment of this phenomenon where, without grass visible lesions of cerebral tissue, a high mortality occurs. The clinical features, the princip1es of therapy and the outcome are described by Vigouroux and Guillermain, whose clinical study clearly demonstrates the limitations of all our efforts in severe brain injuries, in spite of decades of clinical experience and research."

Amaurosis fugax, or "fleeting blindness," has been known as a clinical entity for hundreds of years (1). Since 1859, we also have understood that the phenomenon frequently is related to atheroembolic disease and that it is considered a classic manifestation of ocular transient ischemic attacks and a potential precursor to stroke. However, many questions about this syndrome have remained unanswered until quite recently, when a great deal of new information and thought has been directed to the subject. Transient monocular blindness (TMB) is only one manifestation of a complicated syndrome of ocular, systemic, and cerebral diseases that may include some degree of monocular blindness. The duration of blindness varies from very brief (seconds) to complete and permanent. The per manent type is referred to as ocular infarction or ocular stroke. Retinal infarction is the most severe degree of monocular blindness and usually is due to embolic occlusion of the central retinal artery or one of its branches. Varying types of arterial emboli have been described, including thrombus, cholesterol, platelets, and fibrin.

This long-awaited second edition has been thoroughly updated and revised by Dr. Michael Salcman with the assistance of Edward R. Laws, MD, Roberto Heros, MD, and Volker Sonntag, MD, yet still preserves the user-friendly aspects of the original book: brevity and ease of practical application in the operating room environment.

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

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

In the rapidly-evolving landscape of neurosciences, it is no easy task to select a limited array of topics to present in a text such as this. The current volume takes as its purpose to provide a representative survey of the current science of brain repair for those seeking to establish a foundation in the field or to replenish a prior knowledge base that may have lapsed in its currency. It also hopes to offer insights into what remains elusive to our collective investigations, defining the frontiers of brain repair for those that are currently immersed in the exciting intersection of biological advances and neuroscientific discoveries.

In Chapter 1 the fundamentals of imaging transplanted cells is discussed with emphasis on animal models as well as the horizon for clinical trials. Then, detailed methods on the culture of neural stem cells is reviewed as a foundation for approaching therapeutic goals. Chapter 3 presents the broad scope of animal models that serve as the foundation for developmental and pre-clinical investigation, with mention of recent genetically engineered mouse models that represent the best models for studying disease development and treatment. Chapter 4 provides background on the delivery techniques to animals and patients that are available, providing vital information on the subtleties of technique necessary for optimal cellular grafting. Chapters 5 and 6 discuss new and evolving information on the origins of brain tumors and the indelible role of stromal and microenvironmental influences on oncogenesis and tumor progression. Subsequently, the utility of neural stem cells as cellular vehicles to deliver chemotherapeutics to broad neuropathology is reviewed. In Chapter 8 the scope of treating brain tumors is expanded beyond stem cells, to present the best biological interventions to improve upon current treatment options for brain malignancy. The last two chapters present a comprehensive review on stem cell and gene therapy options for treating cerebrovascular and neurovascular pathology.

In amassing this collection, my intention has been to provide the reader with a broad introduction into molecular imaging, stem cell biology, cell therapy, animal models, central nervous system malignancies, stroke, and neurodegeneration. My hope is that Frontiers of Brain Repair will be the intellectual soil from which a deeply rooted and well-nourished vintage of neuroscience will arise."

Recent advances in technology have opened up new possibilities in the diagnosis and treatment of cerebrospinal vascular diseases. It is now possible to use magnetic resonance imaging to map brain function and metabolism as an aid to diagnosis. Novel applications of magnetic resonance angiography allow three-dimensional imaging, and the magnetization transfer contrast technique gives us a new window on cerebral vascular function. This volume presents work in all these fields as well as previewing the techniques of endovascular surgery for cerebrospinal vascular diseases. These include modern stereotactic radiosurgery for arteriovenous malformations and for angiographically occult vascular malformations of the brain. This book presents an overview of the latest applications of technology to this rapidly developing and challenging field.

The current book represents a distillation of the experience gained in diagnosis of intracranial tumors with computed X-ray tomography at the University Hos pitals of Berlin, Mainz, and Miinchen. To what purpose? Standard radiological techniques such as pneumoencephalography with lumbar puncture and cerebral arteriography with puncture of the common carotid artery are invasive proce dures which entail a certain amount of risk as well as discomfort for the patient. Furthermore, diagnoses made with these procedures rely primarily on indirect signs of an intracranial space-occupying lesion - such as displacement of the air-filled ventricles or of normal cerebral vessels. Only a few types of tumor are demonstrated directly with these techniques. In contrast, computed tomography demonstrates the pathology directly in almost all cases, and this with a minimum of risk and discomfort. In addition, normal intracranial structures are demonstrated, so that the tumor's effect on its surroundings can be evaluated. Today, almost a decade after HOUNSFIELD'S revolutionary invention, diagno sis of brain tumors without computed tomography is almost unthinkable, if not in fact irresponsible."

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

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."

The International Brain Hypothermia Symposium 2004was the second time I have had the honor of opening such a gathering on brain hypothermia treatment. It was a great pleasure to greet the participants in the hope that their valuablecontributions would make the Tokyo meeting memorable. Brainhypothermia has long been seen as a promising method that may overcome current limitations on brain resuscitation in patients with severe brain damage. However, although excellentresults have been obtained in experimental animal models, for some reason brain hypothermia has not alwaysbeen successful clinically, and resolving this problem has been a major challenge facing physicians specializing in brain therapies. The ICUmanagement of recent research has uncovered newmechanisms ofbrain damage not seen in animal models, including brain thermo-pooling at temperatures above 40 C in severe brain damage, masking neuronal hypoxia even with normal cerebral blood flow. Stress-related hyper glycemia with brain hypothermia was expected to generate useful results in patients with external injuries, cerebral occlusive stroke, and cardiac arrest. In recent clinical studies of brain hypothermia treatment, many excellent results began being reported on the manage ment of severe brain injury, ischemic stroke, and post-resuscitation after cardiac arrest. However, in clinical brain hypothermia treatment many questions remained about appro priate treatment targets, leu management technique, prevention of complications, control of brain tissue temperature, management of hypothermia insult, and mechanisms underly ing the onset of vegetative states."