There are two important reasons for commencing this new series of publi cations entitled "Advances and Technical Standards in Neurosurgery": 1. the lack of any organized common European postgraduate training system for young neurosurgeons and 2. the language barriers, which impede the exchange of neuro surgical 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 will be written by specialists in the given fields and will constitute the first part of each volume."

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

''Emphasis on new issues and emerging concepts insures that the information presented is still timely...A compelling source of information on recent research in the field.'' ---Journal of Chemical Neuroanatomy, May 1997

"Research" and "Publishing" are phrases familiar to all neurosurgeons and neuroscientists. Many young neurosurgeons struggle with them on a trial-and-error basis at first, and there are not structured education programs providing information on standard methods. The European Association of Neurosurgical Societies Research Committee has developed a course on research and publication methods for residents in neurosurgery who have not yet completed training. This supplement includes selected contributions from this course and will serve as an essential handbook providing basic tools to guide research and publication work, presenting time-saving advice, and resulting in the most beneficial contributions in experimental and clinical research.

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 puhlicationR 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 training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons.

During the last decade research on neural transplantation in mammals has grown extensively, and has attracted the attention of many young inquisitive scientists. This growth, as the critics point out, has been somewhat random, and has resulted neither in the formulation of basic concepts nor in any other significant achievement. For instance, they question-how is it possible to jump into functional research with clinical bearing when the basic morphological work has not yet been conducted? The criticism, objectively speaking, is valid and is supported by the fact that every investigator who has stepped into this unex plored field of neurosciences has formulated questions in his own way, has followed his own "model" oftransplantation, and has arrived at his own unique conclusions. The potential danger, as the critics emphasize, in this type of approach lies in that instead of evolving into a scientifically solid and valuable field of research, it may end in a confusing and conflicting mass of questionable claims and subjective opinions. The present situation, very likely, is a reflection of unrestrained enthusiasm and imaginativeness of the investigators, and the demands of the times for the so-called "newsworthy" and "breakthrough" publications. Despite these limitations, two important facts have been estab lished in this field. First, as far as transplantation of neural tissues per se is concerned, what was considered impossible by some critics about 10-12 years ago has been shown to be possible."

It is estimated that the fU, nctionally significant body of knowledge for a given medical specialty changes radically every 8 years. New specialties and "sub-specialization" are occurring at approximately an equal rate. Historically, established journals have not been able either to absorb this increase in publishable material or to extend their readership to the new specialists. International and national meetings, symposia and seminars, workshops and newsletters successfully bring to the attention of physicians within developing specialties what is occurring, but generally only in dem onstration form without providing historical perspective, pathoanatomical correlates, or extensive discussion. Page and time limitations oblige the authors to present only the essence of their material. Pediatric neurosurgery is an example of a specialty that has developed during the past 15 years. 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 investigative studies into all as pects of surgically treatable diseases of the child's nervous system."

Sleep plays an important role in the history of the neurosciences. On Easter Monday in 1920, Otto Loewi was awakened in the night by a dream in which he conceived of neurotransmitters communicating across the synapse. He quickly made notes, but in the morning he could not understand his scribbles. The following night, the dream came again. He wrote down his thoughts more carefully and, the next day, conducted the crucial experiment that launched modern neu rophysiology (Koelle, 1986). Since the beginning of the modern era of sleep research in the 1950s, we have used the principles of neurotransmission to explore the regulation of sleep. Without resorting excessively to comments on blind men and elephants, however, it is fair to say that the phenomena of sleep and waking can be approached from many perspectives. Among other things, sleep is a process that can be described electri cally, an experience that so far defies physiological measurements, and a social behavior. In this book, I have tried to describe the physiology and pharmacology of sleep (Part I) and to relate them to clinical sleep disorders (Part II). Having neither the skill nor the grandiosity of Rous seau, I have made no attempt to write an encyclopedia of all that is known on the subject. Rather, I think of this book as more of a snap shot, giving a picture of where we are, and it is hoped, a history of how we got here."

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.

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."

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 Euro pean 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 postgraduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons."

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.

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."

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.

Intracranial germ cell tumors are a group of uncommon neoplasms of the central nervous system. The clinical features and natural history of these lesions are quite unique and variable. While intracranial germ cell tumors have been a fascination to neurooncologists for decades, the relatively small number of patients seen in any single institution has hampered the important clinical investigation that is so needed. This text is complete with detailed information concerning the epidemiology, pathology, oncological biology, clinical findings, radiology, and treatment options including surgical strategy, radiotherapy, and chemotherapy for this heterogeneous group of neoplasms. The ongoing clinical trials concerning the optimization of therapy are efficiently summarized. An important final segment addresses the late sequelae of therapy which is of great significance since the majority suffering from these tumors are young patients. This first and only book on intracranial germ cell tumors includes excellent and comprehensive data sheets, illustrations, and radiograms. It provides a detailed and outstanding reference source for physicians taking care of patients with intracranial germ cell tumors, and will be a very welcome edition to their reference libraries.

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."

The Omentum explores and assesses the comparatively new approach of using omental attachment in the treatment of a variety of neurologic diseases. Topics discussed include historical images and ideas connected with the greater omentum; angiogenesis and the greater omentum; implications for central nervous system injury of vasoactive chemicals in the omentum; effects of omental-derived lipid fractions on osseous vascularization and bone formation; cerebral revascularization by omental graft for moyamoya disease; omental transposition for treating the sequelae of viral encephalitis; experimental and clinical use of omental transposition for spinal cord pathology; and lumbo-omental shunt for treatment of communicating hydrocephalus. The effect of omentum transposition to the brain on regional cerebral blood flow in stroke patients and on delivery of chemotherapeutic agents to malignant brain tumors is also considered.

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.

This volume represents the Proceedings of the Symposium on AIDS, Drugs of Abuse and the Neuroimmune Axis. This meeting was held in San Diego, California, November 11-13, 1995. As in the previous symposia in this series, productive studies were reviewed concerning the relationship between the nervous and the immune systems in regards to the relationship between drugs of abuse and infections, especially infections by the immunode ficiency virus that causes AIDS. In recent years, various investigators have begun to describe the role of illicit drugs and their endogenous counterparts on the brain-immune axis. It is widely recognized that the neuroendocrine system is intimately involved in the effects and manifestations of the interactions of drugs of abuse and the immune system. The meeting on which the chapters in this book are based brought together many biological scientists from an array of various scientific disciplines whose work is focused on the effects of drugs of abuse on the neuroendocrine-immune axis and its relationships to immunodeficiency caused by the AIDS virus. As in the past, the symposium was unique in focusing on the . brain-immune axis from the viewpoint of drugs of abuse rather than from the viewpoint of immunity or the brain itself."

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."

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."

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.