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

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."

Endoscopic neurosurgical interventions gain in importance. This book gives adetailed description of the recent indi- cations of endoscopic procedures inmodern neurosurgery. They include endoscopic stereotaxy, endoscopic evacuations of intracerebral hematomas, cysts and abscesses as well as endoscopic interventions on brain tumors. An extended over- view about the usable endoscopes and the operative equipment is pointed out

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.

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

This volume represents the proceedings of the 2nd annual symposium on the Brain Immune Axis and Substance Abuse held at the Breakers Hotel in Palm Beach, FL in June 1994. The history of productive studies concerning the relationship between the nervous and the immune systems is relatively recent. Studies on the effects of drugs of abuse on the immune system and on infections among individuals who abuse drugs are also of recent vintage. Only in the last decade have investigators begun to describe the role of drugs of abuse and their endogenous counterparts on the brain-immune axis. Thus, the involvement of the neuroendocrine system in the interactions of drugs of abuse and the immune system has only recently been appreciated. In addition, it has been recognized that direct neural inputs impact immune function. Given the complexity of these interactions, characterization of biologically significant phenomena and elucidation of their mechanisms of action often requires a multidisciplinary approach. This meeting, on which the chapters in this book are based, brought together scientists from an array of biomedical disciplines whose work is focused on the effects of drugs of abuse on the neuro-endocrine immune axis. The meeting was unique in focusing on the brain-immune axis from the viewpoint of drugs of abuse rather than either immunity itself or the brain itself. Presentations addressed the direct effects of drugs of abuse on various components of the immune system, as well as those mediated indirectly by the central nervous system and the neuroendocrine system.

From recent developments in the rapidly growing area of neuroscience it has become increasingly clear that a simplistic description of brain function as a broad collection of simple input-output relations is quite inadequate. Introspection already tells us that our motor behavior is guided by a complex interplay between many inputs from the outside world and from our internal "milieu," internal models of ourselves and the outside world, memory content, directed attention, volition, and so forth. Also, our motor activity normally involves more than a circumscribed group of muscles, even if we intend to move only one effector organ. For example, a reaching movement or a reorientation of a sensory organ almost invariably requires a pattern of preparatory or assisting activities in other parts of the body, like the ones that maintain the body's equilibrium. The present volume is a summary of the papers presented at the symposium "Sensory Interaction in Posture and Movement Control" that was held at Smolenice Castle near Bratislava, Slovakia, as a Satellite Symposium to the ENA Meeting 1994 in Vienna. The focus of this meeting was not only restricted to the "classical" sensory interactions such as between vestibular and visual signals, or between otolith and semicircular canal inputs. Rather, the symposium tried to consider also the interplay between perception and action, between reflexive and volitional motor acts as well as between sensory driven or self-initi ated motor acts and reafferent inputs."

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.

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?

Because stroke is essentially a disease of the vessels and blood flow, the most fundamental aspects of ischemic blood flow in the brain are under investigation by researchers. Their work was the focus of the sixth in the series of Keio University International Symposia for Life Sciences and Medicine, held in Tokyo in 1999. Selected here are 55 papers from the symposium, covering the buffy coat (glycocalyx) of endothelial cells, the blood-brain barrier and permeability, gene expression, vascular reactivity, dysregulation, inflammatory deterioration, cortical spreading depression, edema, microvascular derangement, and pathology, in ten major sections. The book includes the thought-provoking discussions that followed the presentations, thus providing an invaluable source of up-to-date information not only for researchers investigating microcirculation but also for clinicians implementing the most effective treatment for stroke patients.

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.

We are most pleased to present Volume 3 of Developmental-Behavioral Disorders: Selected Topics, designed to serve as a companion for standard reference textbooks that address cogent issues in developmental pedi atrics. Periodic publications such as Selected Topics and theme-related articles, as well as continuing education programs, attempt to supple ment in a timely fashion the rapidly changing knowledge base in devel opmental-behavioral pediatrics. These media are important as forums for enhancing the quality of clinical practice, teaching skills, and re search activities. The need is critical for periodically disseminating and updating information about issues in developmental medicine, in as much as this field of study continues to expand at a meteoric pace. During the past several decades, developmental medicine has been recognized as a defined subspecialty in pediatrics. The spectrum of problems encompassed by this discipline is relatively broad and at times clinically overwhelming. The ultimate goal of preventing delays, disor ders, and/or dysfunctions from becoming chronic handicapping condi tions has, by volume per se, created clinical dilemmas for pediatric health care providers. There are numerous facets of providing efficient and effective care, which in the field of developmental-behavioral pediatrics are often exaggerated impediments to the delivery of services by pri mary health care specialists, e. g., time, clinical skills, need for inter disciplinary management, medical-legal responsibilities, financial reim bursements. These issues, as well as clinical problems, are still very much part of the information base to be disseminated to concerned pro fessionals."

This volume contains the proceedings of the latest in a series of international symposia on advances in neuro-oncology, held September 26-29, 1990, in San Remo, Italy and sponsored by the University of Pavia, I.R.C.C.S. Policlinico San Matteo (Pavia, Italy) and the Giovanni Lorenzini Medical Foundation (Milan-Houston). It drew papers from six continents of the world, was attended by over 500 investigators, and demonstrated the extraordinary vitality, depth and breadth of research which characterizes modem neuro-oncology. Over the course of the last decade, there has been a remarkable shift in research carried out in the heterogeneous field of neuro-oncology, which appears to be away from clinical descriptive studies, and toward more basic and fundamental investigation of the pathology, immunohis tochemistry, biochemical and cellular subsets of brain tumors. Besides the traditional fields of neurology, neurosurgery, neuropathology, and radiation therapy, there has been an increased interest and involvement by investigators in the fields of medical oncology, neuroradiology, immunology, and many areas of fundamental neurobiology. It has become evident that interest has also been exhibited in a broader spectrum of tumors than just the malignant glial series, and studies in meningioma, craniopharyngioma, neurinomas, and the pituitary tumors were reported. Several sessions were devoted to the special problems of pediatric brain tumors."

"Spasticity is one of the commonest sequelae of neurological disease and during the last few years many advances have been made in the treatment of this complaint by functional neurosurgery. This book ... will appeal to neurosurgeons, orthopaedic surgeons and neurologists amongst others. Annals of the Royal College of Surgeons of England"

Brain edema is a simple phenomenon - an abnormal increase of brain tissue volume by the increase of brain tissue water content. However the etiology is not simple and relating to a wide variety of neurological disorders including ischemia, trauma, tumor, hemorrhage and hydrocephalus. It is still a major cause of death in the neurological/neurosurgical ward. This volume is an up-to-date report on progress in brain edema research, diagnosis and treatment, including papers presented at the 12th International Symposium on Brain Edema and Brain Tissue Injury in 2002. Major topics include molecular biology and blood-brain barrier disorders, ischemic and traumatic brain edema, imaging and diagnosis of brain edema, treatment and radiation effect. Various papers in the rapidly growing fields of neuroimaging and molecular medicine are also included.

Recent breakthroughs in understanding the effectiveness of brain hypothermia treatment have been brought about by rapid progress in experimental gene studies along with new findings in the areas of brain-injury mechanisms, brain thermo-pooling, hemoglobin dysfunction, insulin-resistant hyperglycemia, radical damage involving states of consciousness, management of lipid-dominant metabolism in the intensive care unit (ICU), and management of immune crises under conditions of hypothermia. This book explains the mechanism of brain hypothermia and presents advanced techniques for ICU management of brain hypothermia for critically brain-injured patients. Especially useful for bedside care in the ICU are the easy-reference care-management "cards" in the appendix of the book. Brain Hypothermia Treatment provides a valuable resource and practical guide for professionals in the fields of neurosurgery and emergency and critical care medicine.

Business tycoon, Marine, husband, father, pilot; Harold Holder nearly had his life extinguished by a silent monster building within his skull. Originally misdiagnosed as bacterial pneumonia, Holder's actual injury and ensuing surgery carry a mortality rate of more than 50%. His neurosurgeon would later tell him it was the worst he had ever seen. Compiled from a detailed journal that physical therapists encouraged Holder to write throughout his recovery, Please Leave the Lights On is a story of dramatic recovery fueled by personal drive and desire. Waking up immobile on a hospital bed deep within the Intensive Care Unit, Holder struggled to determine how much of his mental function remained post-surgery. Unable to test his physical abilities, he exercised his mental capacity by running cherished memories through his mind, attempting to remember specific names, places and dates. On the brink of death, Holder fought to regain his health during turbulent economic times when crooked bankers and lawyers threatened to take advantage of his injury and dismantle his empire. One incremental step at a time, Holder began to make progress in restoring his health, his business and his life-proving that recovery is possible even under the most trying circumstances.

The international interdisciplinary gathering of top of secondary brain damage in brain trauma, as ac- level clinical and laboratory scientists in Mauls, Italy knowledged from the beginning of these workshops in has developed from its beginning in 1984into a fruitful Mauls, the significance of inflammation is all but clear. tradition where worldwide experts active and knowl- Although inflammatory phenomena are seen in trauma edgeable in cerebral ischemia and trauma convene for and ischemia ofthe brain, as activation ofwhite blood update and exchanges of their most recent clinical and cells with emigration into the tissue presumably en- experimental findings and concepts. These meetings hancing damage, inflammatory cells may have benefi- have, of course, experienced shifts in emphasis from cial properties as well. Thechapter on the Janus-faceof the past until now, corresponding to the most actual inflammation isanalyzing this ambiguity. developments, which were fascinating clinicians and The exploration of novel cell-biological mechanisms laboratory scientists alike. The current Supplement of on a molecular or more systemic basis causing apop- Acta Neurochirurgica is an example in case. Its virtue totic cell death, inflammation, or regeneration, provide as before is that authors contribute articles in a review- useful objectives for therapeutical interventions ex- like manner on their own field of research, according pected to be more specific than the present treatment to the platform presentations at the meeting as indis- modalities.

Gamma knife radiosurgery has grown continually in importance in recent years. However, there was a lack of established clinical and physical quality standards and a good knowledge of the possibilities of radiosurgical treatment for brain lesions. This book fills the gap by giving an overview of the current status of European gamma knife radiosurgery. Leading european experts report on their specialities in this field which is a state-of-the-art summary of the possibilities and results of their current work. The book encompasses all important as well as the more rare indications. All relevant technical and clinical quality standards are addressed. Tailored planning strategies are described for different indications. All professionals who care for patients with neurosurgical disease, such as neurosurgeons, radiosurgeons, radiologists, radiation oncologists and neurologists will find the book highly useful for the management of patients with benign and malignant brain lesions in a multidisciplinary setting.

This 'in vivo' atlas contains more than 50 magnetic resonance (MR) images of the brain. Each structure is represented in the axial, coronal and sagittal plane, magnified in colour schemes and reconstructed in 3D images with a useful millimetric scale. The atlas offers the reader a practical and simple tool for surgical planning and for diagnostic and anatomical studies. The high level of anatomical definition of the in vivo MR images means that there is no loss in precision as a result of post-mortem changes. No doubt, this book is an excellent teaching instrument for all students of the neurosciences, regardless of the individual level of training and expertise.

Advances in epilepsy in recent decades have allowed for improved algorithms for diagnosis and a common understanding of terminology with the development of the International Classifications of Seizures and the Epilepsies. Nevertheless, no common system exists for the estimation of epilepsy severity or its impact on quality of life. Therefore, epileptologists lack the ability to make quantitative assessments of individual patients for comparison of care or for meta-analyses in clinical trials. This book on the Quantitative Assessment of Epilepsy Care approaches this omission by addressing the potential application of clinimetrics within the framework of epilepsy treatment. Clinimetrics is a fast growing discipline concerned with the quantification of clinical symptoms with respect to decision making relating to diagnosis, treatment, and prognosis. These methods allow for the development and validation of clinical scoring systems. For example, the Glasgow Coma Scale is widely used. As a chronic disorder, epilepsy would benefit from clinimetric methodology to create uniformity and to allow for comparisons among evaluations. In addition, epileptologists have not yet developed assessments of health related quality of life to define the overall condition of the chronic epilepsy patient and various therapeutic endpoints. While clini metric tools are essential for research, they will also be useful in clinical practice for the care of individual patients by documenting status and changes over time. This treatise will provide critical analyses of whether existing rating scales and techniques are valid to use, and which types of scales and techniques require further development.

In reflecting upon my life as a neurosurgeon, perhaps the most salient feature is that period of history involved. Trained by men who studied under Harvey Cushing, considered the father of neurological surgery, we, as early third-generation neurosurgeons, were held to those rigid standards of academic achievement and physical endurance typical of that time. The reader first identifies with the young child who dreams of becoming a doctor, and then sets out on that long path. He then re-lives the experiences of the student of medicine, and later the rigorous demands placed upon the surgeon-in-training. During the later descriptions of the private practice of brain and spinal surgery, the book transitions into an educational experience. It presents to the reader a multitude of neurological disorders requiring surgical treatment, the relevant surgical anatomy and the operative techniques involved. Often interjected are the intangibles of surgical judgment and philosophy when confronting those in pain or critically ill. Of equal importance were the major scientific advancements which occurred during that period of medical history. No longer did we have to bore a hole in the skull, or inject noxious materials into the head or spinal canal to verify a diagnosis. Rather, we had been privileged to enjoy the development of such remarkable machines as the ultrasound, CAT, and MRI. Descriptions of these devices, among others, and their impact on medical practice should prove interesting to the inquisitive reader. After 21 years in practice, and probably at the height of my career as a surgeon, I contracted hepatitis B subsequent to an accidental needle puncture in the operating room. Forced to lay down the scalpel, I turned to my second childhood dream, cattle ranching, as an alternative vocation. This then becomes a secondary focus of the book. A medical colleague, after learning of my book, expressed an interest in learning the common denominator driving a man to both neurosurgery and ranching. One can summarize with the word, "counterpoise." I had always strived to achieve a balance between the in-hospital, academic, precision-oriented work of the neurosurgeon and the outdoor, physically-demanding life of a rancher consummating the total American dream. Analogous to surgery I have always enjoyed using my hands in the shop. Throughout the book sections have been devoted to various aspects of woodworking, and an effort not only to share my enthusiasm but also to expose underlying problems and pitfalls; challenges I have encountered in striving to become an artisan of fine furniture. The practice of medicine has undergone significant change during my lifetime. Not only have I witnessed a burgeoning, unsustainable increase in the cost of healthcare, but also major changes in the way in which medicine is being practiced in the new millennium. Having been a proud product of the "Lucky Few" generation, born between the years 1929 and 1945, I am rightfully able to compare today's practice of medicine with those of the latter half of the 20th century.

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 of European co Hugo Krayenbtihl. Thus were established the principles 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 publi cation of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume.

INHALT: The Concept of the BBB: an Historical Perspective Anatomy of the BBB Pathophysiology of BBB * Brain oedema Breakdown of the BBB BBB Dysfunction after SAH * Clinical Monitoring Neuroradiological Evaluations of BBB Dysfunction after SAH * Computerised Tomography and Magnetic Resonance * SPECT and PET Experimental Data * Literature Review of BBB Dysfunction after Experimental SAH * Qualitative Assessments * Quantitative Assessments * Time Course of BBB Dysfunction after SAH * Additional Pathophysiological Changes after SAH - Cerebral Vasospasm - CSF Eicosanoids - Cerebral Metabolism - Behavioural and Neurological Deficits - Intracranial Pressure - Blood Pressure, Blood Gases, Plasma pH, Plasma Glucose, Body Temperature Strategies for Pharmacological Interventions * Hydroxyl Radical Scavenger AVS * Glutamate Antagonist Felbamate * Calpain Inhibitor II Challenges and Future Directions * Advances in Cerebrovascular Pathophysiology Elucidation * Gene Therapy

It is estimated that the functionally 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, estab lished 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 success fully bring to the attention of physicians within developing specialties what is occurring, but generally only in demonstration 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 train ing 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 aspects of surgically treatable diseases of the child's nervous system."