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

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

Increasing specialisation in pathology reflects the progressive changes in medical practise. The advent of a specialist with a new interest in a hospital or clinic may present the pathologist with a need to extend his or her knowledge to be able to work closely with the clinical practi tioner in order to provide adequate clinical care. Some sub-specialisations are long established, such a one is neu ropathology. However, an exclusive specialist practise is generally con fined to neurosurgical centres and much neuropathology is of necessity, executed by geneni.l pathologists. The areas covered by this volume are those which are commonly managed by the generalist. Professor Adams' account of how the skull and brain should be examined here will give confidence to many by defining a good technique and the careful description of various kinds of vascular injury lesions resulting from raised intracranial pressure will help to clarify repeated difficulty. More subtle forms of damage are also considered in detail. Professor Weller provides a detailed account of how the central nervous system may be examined in a way which permits all of us to prepare material which will allow adequate investigation of central nervous system disease and the proper examination of peripheral nerves. This chapter will become a "handbook" and will be of interest to those in training and established practitioners. Muscle biopsy is also dealt with; this is an area of investigative concern for many gener alists. The role of that singular neuropathological technique is very clearly emphasized.

This book is a compilation of scientific papers presented at the Seventh Interna- tional Symposium on Intracranial Pressure and Brain Injury, held in Ann Arbor, Michigan, USA, June 20-23, 1988. The symposium explored both clinical and basic science aspects of intracranial pressure dynamics and their clinical applica- tion. Neuroscientists including neurologists, neurosurgeons, neuroanesthesiolo- gists, neuroradiologists, neurochemists, biophysicists and physiologists contrib- uted to the state-of-the-art presentations and discussions. Open exchange of ideas characterized this meeting as it did the initial meeting in Hanover, Germany in 1972 and subsequently at tri-annual meetings in Lund, Sweden; Groningen, Holland; Williamsburg, Virginia; Tokyo, Japan; and Glas- gow, Scotland. The next Intracranial Pressure Symposium, to be held in Rotter- dam, Holland, in 1991, will continue this tradition. The papers in this book have been grouped for the reader's convenience. Clinical and basic science papers focus on the same subject, consequently they appear together. Subjects include monitoring; biophysics; CSF dynamics and hydrocephalus; control of intracranial pressure; trauma, hemorrhage, and in- flammation; free radicals; cerebral perfusion and metabolism; and brain edema. The science of intracranial pressure and its relevance to human illness con- tinues to provide fascination for investigators throughout the world. This book reflects the research of many of them and, hopefully, will stimulate new and innovative inquiries.

The proceedings of the XVth Congress of the European Society of Neuroradiology are presented in this volume. The four main topics are: new imaging of brain metabolism, the spine and cord, interventional neuroradiology, and free communications including multiple sclerosis, AIDS and the hypophysis.

In June 1973, Professor George Austin invited a small group of neuroscientists from Asia, Europe, the United States, and Canada to the Loma Linda University School of Medicine in Loma Linda, California. The fundamental technique of fashioning a small vessel collateral to the brain had been pioneered by Donaghy and Yasargil 5 years before and was now gaining momentum with the increased availability of the operating microscope, fine instruments and sutures, and surgeons trained in microvascular surgery. The interchange of ideas at this first conference was magic. The handful of participants returned home stimulated with new ideas of technique, patient selection, and postoperative evaluation and resolved to meet again on a regular basis. A Second International Symposium was hosted by Howard Reichman at Loyola University in Chicago, Illinois in June of 1974; a Third Symposium at Rottach-Egern, West Germany in June of 1976 under Professor F. Marguth of the Ludwig-Maximilians-University of Munich.

In this volume, one of a series of monographs devoted to the problems of cerebral ischemia and related topics, we present the proceedings of an international conference on Cerebral Ischemia and Basic Mechanisms held in Bad Schachen/Lake Constance, Germany in June 1992. The enormous progress in research recently on the basic mechanisms associated with cerebral ischemia has provided greater insight into the pathophysiological mechanisms of reduced brain perfusion and decreased cerebral metabolism. The high technology instrumentation used to unravel the intricacies of cerebral blood flow and metabolism includes positron emission tomography and magnetic resonance imaging. A description of sophisticated neurophysiological techniques will give the reader insight into new models of reversible and irreversible tissue damage and changes at the molecular level have been described. The therapeutic approaches which have developed from this re search have been or will be used in clinical trials and will open new avenues in the treatment of stroke. The organizers of the meeting would like to thank the advisory board for its helpful suggestions and the Deutsche Forschungsgemeinschaft and other sponsors for their important support."

The aim of this volume is to provide an illustrated overview of basic knowledge relevant to neurosurgery for students specializing in neurosurgery, operating room personnel, and neurologists seeking to inform themselves about surgical principles and applications. The major aspects of neurosurgery are presented in a clear, easy-to-follow outline form. Summaries are included of: neuroanatomy; neurologic syndromes, functional diseases, and traumas treatable through neurosurgery; physiologic and pathologic events occurring during neurosurgery. The principles of neurologic examination and diagnosis as well as supplementary diagnostic modalities are discussed from a neurosurgical perspective. The book can thus be used as an aid for quick bedside diagnosis and patient management and as a handy reference companion.

Hughlings Jackson, the noted English neurologist, fathered many ideas that today still underlie our understanding of common clinical phenomena. This is a reappraisal of Jackson's work, both within its historical framework and in light of modern concepts of neurology. The approach is new, combining historical, clinical and basic scientific information in one synthesis on the organization and function of the nervous system. The concept of levels of function is addressed, specifically with regard to areas of brain function; and the hierarchical strategy is considered as part of the current concept of a distributed system of neurons. Clinicians and scientists alike will find much food for thought in this modern treatise of Jacksonian concepts.

Over a mere 5 years, neonatal cranial sonography has evolved from an obscure and largely experimental imaging possibility to the modality of preference in the examination of the young brain. The almost immediate acceptance of the ultrasound examination of the neonatal brain was based on a number of coinci dent factors, the most important of which was the emergence of a burgeoning population of premature neonates who were, for the first time, surviving be yond infancy. These delicate patients were beginning to withstand the rigors of extrauterine life when not fully prepared for it; pulmonary, cardiac, and infec tious diseases no longer claimed most of them. With survival, a new specter reared its head: Would the eventual mental and neurologic status of these same children be worth the expense and time needed to bring them through their first months? This issue became increasingly pressing as evidence mounted through the 1970s that very premature neonates were at a high risk for intracranial hemor rhage and posthemorrhagic complications. An imaging modality that could evaluate the premature brain was sorely needed. The CT scanner with its proven ability to diagnose intracranial hemorrhage was of little value in this regard. So too were static gray-scale or waterpath ultrasound units. These modalities all had the same limitation, lack of portability. As neonatal intensive care units proliferated, so did the technology that would soon allow cribside neonatal neuroimaging, the real-time sector scanner."

A state-of-the-art presentation of intraoperative neuro- physiologic monitoring by specialists from well-known international medical centers.

The spinal cord has a characteristic structure and functions that are distinct from those of the brain. Its functions are tremendously important since it modulates the peripheral sensory inputs to the dorsal horn, and it gives rise to the ascending pathways transmitting peripheral afferent inputs to the brain, and conveys the descending pathways from the brain both to the lower motor neurons, the final common pathway, and to dorsal horn sensory neurons. In spite of these vital functions, the spinal cord constitutes only a small percent age of the mass of the human central nervous system and is located far from the skin surface, which has obstructed the recording of its electrical activity. Recently, however, important advances have been made in several recording techniques, including epidural recording or averaging methods, allowing both sensory and motor evoked spinal cord potentials in man to be recorded. This volume is based on the papers presented at the Fourth International Symposium on Spinal Cord Monitoring and Electrodiagnosis. Each of these international symposia has brought together many of the specialists involved in this research, with an important increase in the number of participants since the first symposium was held in Toyko in 1981. At the past symposia several attempts were made to standardize data, techniques, and clinical applications and to integrate the new findings into patient care."

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."

The blood-brain barrier is still not completely understood and therefore the subject of fascinating study. How are endogenous substances transported through the blood-brain barrier? What are the known therapeutic and toxic agents? How are they transported across cerebral microvessels? The discussion of these and other questions with far-reaching consequences for all neuroscientists can be found in this volume. This authoritative and up-to-date review of the blood-brain barrier gives a proper understanding of the topic. The experimental principles, the results of very recent research, as well as the implications that experimental research has for clinical treatment are thoroughly covered. Information is given on: - new findings based on classical physiological and pharmacological techniques, - results obtained from brain capillaries in vitro and in culture, - results obtained from the new scanning techniques (PET and MRI), - the immunology of the blood-brain barrier, - trace metal transport, - the pathological breakdown of the barrier and - the modification of drugs to increase their entry into the brain. Here is a source of information that is invaluable to specialists concerned with basic research in the neurosciences, with the design of neuropharmacological agents, with the radiological diagnosis of cerebral pathology or with the treatment of cerebral lesions!

The rapid development of diagnostic and therapeutic procedures in the management of spinal angiomas has opened up new possibilities and provided better chances for the patients concerned. The greatest impetus to this pro gress was given by the introduction of selective and superselective spinal angiography, microsurgical technique, and embolization. These sophisticated techniques and the skill required for their use are far from being routine in the neurosurgical and neuroradiologic departments. In spite of the rarity of spinal angiomas, the application of the above-mentioned procedures is the prerequisite for improving early diagnosis and giving timely adequate treat ment. Delay in diagnosis and treatment are still the main cause of unsatisfac tory results. In the last 10 -20 years, several groups in Europe and the USA have done important and fundamental work in introducing and developing the diganos tic and therapeutic armamentarium. Based on the pioneering work of their teachers and the classic contribution of Wyburn - Mason in 1943, they simultaneously improved the morphologic, physiologic, and clinical basis of our knowledge. Although progress is going on and many problems have to be solved, the general principles of clinical diagnosis, operative treatment, and embolization have been laid down and are to be published in a special monograph on this topic."

Our common interest in surgery of the vertebral artery was born in 1976, when as residents in the same hospital, we attended an attempt by two senior surgeons to treat an aneurysm of the vertebral artery at the C 3 level. Long discussions had preceded this unsuccessful trial, to decide if surgery was indicated and to choose the surgical route. Finally a direct lateral approach was performed, but access was difficult and correct treatment was impossible, resulting in only partial reduction of the aneurysmal pouch. Following this experience, we decided to seek a regular and well defined approach for exposition of the vertebral artery. Review of the literature indicated some surgical attempts, but the descriptions did not give the impression of safety and reproducibility. No landmark on the described surgical route appeared sufficiently reliable. Henry's anatomical work (1917) gave the only accurate description on vertebral artery anatomy, and it became the basis for our work. When the same patient was referred again one year later, after a new stroke in the vertebro-basilar system, we had behind us repetitive experience on cadavers of an original approach to the distal vertebral artery.

There are two important reasons for publishing this new series 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 neurosurgical findings in Europe more than in other parts of the world. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore the Editors have decided to publish all contributions III 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.

This book attempts to combine many different threads into a comprehensible whole. Since the subject is the Gamma Knife and the author is a neurosurgeon, the field of clinical interest is restricted to intracranial pathology. The discipline of radiosurgery now applies to patients who may reasonably be referred by internists, neurologists, otolaryngologists, endocrinologists and several others. Some of the topics, touched upon, such as stereotaxy and the construction of a radio surgical instrument are unfamiliar to the majority of medical men. Other topics, such as those pertaining to the reactions between radiation and living tissue, are not exactly unfamiliar and yet, for most of us, they are not comfortable areas of expertise: in that we have some basic knowledge but not enough to draw conclusions and interpret. In particular, it is not easy to answer the very sensible questions that patients ask, when being considered for this particular form of treatment. The author has attempted to describe the basic relevant phenomenology in terms that should be readily understandable to a non-specialist physician. To do this, he has been heavily dependent on the expertise of a number of mathematically sophisticated collaborators, who have checked his manuscript. They are named in the acknowledgments section. The relevance of the different sections of this book will naturally be assessed differently, according to the experience and interest of the reader. To simplifY access to the information that is required, the book is divided into three main sections.

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. is not intended to compete with the publications of original Our series 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."

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."

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 book on Processes of Recovery from Neural Trauma contains the proceedings of an international symposium which was sponsored by the Weizmann Institute of Science and was held in June 1984 in Israel. One of the central problems in neurobiology and clinical neurology are the processes which underlie the ability of the nervous system to recover from damage. Neurons of the mammalian nervous system cannot be replaced once the generative embryonic period has ended. Thus, recovery after trauma is limited by the degree to which regeneration of damaged neural processes is possible and by the capac ity of uninjured neurons to form new synaptic contacts or to use their existing ones more effectively. The lack of successful axon regeneration in the central nervous system is the reason for the permanent damage and the very limited recovery of function seen in victims of traumatic injury. Over the past few years, research on neural trauma has witnessed significant progress, resulting from interdis ciplinary research carried out in an increasing number of laboratories throughout the world. Accordingly, the book includes reports on the progress made in the forefront of research in this field. We hope that in addition to being a source of new informa tion, readers of the book will be stimulated to work and to generate new ideas and research strategies in this field of research.

Spinal Cord Injury or disease can happen to anyone at any time and the effects can be devastating. I found this out personally when I was thrown from the back of a pick up truck at age 15 was left paralyzed from the waist down. It was during my recuperation as a young teenager that I first gained insight into the importance of rehabilitation. My family, doctors, nurses, fellow patients and researchers who were dedicated to helping me over come my personal tragedy helped me pull through. Today, rehabilita tion medicine is taking great strides and empowering the person with the injury to take control of their future, overcome their setbacks and, through collaborative support, reach their personal goals and potential. Since 1987 the Legacy raised by my Man in Motion World Tour (24901 miles wheeled around the world March 1985-May 1987) has pro $13 million dollars to research and rehabilitation in the areas vided over of spinal cord injury. I hope that in some small way this funding has contributed to the development of the vital programmes that supported me and many others. The effects of spinal cord injury are traumatic and life-shattering and require a skilled interdisciplinary approach. I congratulate those who have contributed to this book and challenge each one of you to never give up on your dreams to find the answers to the optimum treatment of spinal cord injury and disease."

Four years ago the first international symposium dealing with neural transplan tation was organized as a satellite conference to the annual meeting of the Society for Neuroscience in Los Angeles, California. The expanded proceed ings of that symposium were published by Springer-Verlag in 1983 in a volume entitled Neural Tissue Transplantation Research. We were sufficiently pleased with the results of that effort to organize a second satellite international sympo sium on Neural Transplantation and Regeneration in conjunction with the 13th Annual Meeting of the Society for Neuroscience in Boston in the fall of 1983. Paralleling the growing body of research dealing with various aspects of neural transplantation, the scope of this second symposium was broadened to include not only transplantation but also regeneration. Additionally, topics of clinical interest were addressed as well as issues of basic research. The promise apparent in that first conference is still seen in the second as more and more investigators apply their talents in an attempt to understand this infant field of research. The present volume represents an expanded version of the material presented at the second symposium. We wish to thank all of the contributors to the conference and to this volume for their insight and their assistance."

On one of my returns to California, I attended the "Disabilities Expo 88" at the Los Angeles Convention Center. Among the various marvels oftech nology for the wheelchair disabled were stair-climbing wheelchairs, self raising and lowering kitchen cabinetry, and even a completely accessible "dude ranch" experience. At the same time, as a guest of the Southern California Chapter of the National Spinal Cord Injury Association, I was part of a small booth (among the more than two hundred exhibitors) in which we had spinal cord injured people up and walking with a lower extremity bracing system (the reciprocating gait orthosis) used at the PEERS Spinal Injury Program in Los Angeles. I had a young man, a C6/7 level quadriplegic, walking with electrical muscle stimulation and lower extremity bracing. The system is reviewed in Chapter 8 of this book. As these "disabled" persons walked erect and upright among their wheel chair bound colleagues and took long, confident strides past exhibits extol ling the latest technological virtues of yet another "new" wheelchair (Fig. 1), I reflected on the paradox of it all. What a majority of these paralyzed people W0re really looking for was an alteration oftheir disability so that they could more normally function (in an unaltered environment). What the great majority of the exhibitors were offering was an alteration of the environment so that they could more normally function (with an unaltered disability)."