Sensorimotor systems are not rigidly wired predetermined networks but rather highly plastic structures that learn and modify their entire performance in response to changes in external or internal conditions. Lesions or distortions of the system's input, which initially cause a functional disorganization, induce an active reorganization which often leads to a recovery of function. Examples of lesion-induced neural plasticity have been known for some hundred years; however, an awareness of their value as research tools is relatively new. This current interest is a consequence of rapid ly changing ideas concerning the nature of CNS organization. Out of these, concepts are emerging which describe neural nets as modifiable, highly dynamic, self-organizing structures. This trend is clearly reflected in this volume, which contains the proceedings of a symposium held in Bremen in July 1980 as a satellite meeting of the XXVIIIth International Congress of Physiological Sciences. The first part of this conference was devoted to some gen eral aspects of plasticity, discussing the current theories of functional recovery as well as morphological, neurochemical, physiological, molecular, and ontogenetic aspects. The second part dealt with lesion induced plasticity in specific sensorimotor systems of the spinal cord, brain stem, and cerebral cortex."

The decision of Harvey Cushing to leave general surgery and concentrate on the infant field of central nervous system surgery was in retrospect a landmark in the history of neurosurgery. His concentrated work, and also that of his colleague Walter Dandy, originated with the desires of both pioneers to understand surgical anatomy and neurophysiology. The fundamental knowledge and surgical techni ques that they provided became the standard of excellence for several generations of neurosurgeons; so much so that the general belief was that the surgical techniques could not be improved upon. Twenty-five to thirty years ago microtechniques began to appear in a few surgical research centers, they were then gradually applied to clinical neurosurgery and have contributed to a new level of understanding in surgical anatomy and neurophysiology. We are now fortunate to have a new standard of morbidity and mortality in the surgical treatment of intrathecal aneurysms, angiomas, and tumors. It has been said that microneurosurgery was reaching its limits, especially when treating lesions in and around the cavernous sinus and skull base; those lesions notorious for involvement of the dural and extradural compartments, with a tendency to infiltrate adjacent nerves and blood vessels. The dangers of uncontrollable hemorrhage from the basal sinuses and post-operative CSF rhinorrhea appeared unsurmountable. The lateral aspects of the petro-clival region have been of interest to a few pioneering ENT surgeons and neurosurgeons but the cavernous sinus in most respects has remained the final unconquered summit."

Over the past few semesters a group of neurologists, neurophysiologists, and brain theorists in various departments of Tlibingen University have gathered periodically in an effort to review ideas and evidence on cerebel lar functions. At times, general solutions seemed close, when credit was given to various theoretical proposals advanced since the early days of cer ebellar physiology, however, it became clear in every case that a large part of the available facts refused to submit to the general ideas. As believers in the power of scientific discussion, we felt that the time was ripe for posing the problem of the cerebellum once more to a well articulated group of specialists that would include proponents of every disparate point of view. The sponsorship of the Max Planck Society and of the Deutsche Forschungsgemeinschaft, to whom we express our profound gratitude, made it possible to organize an international meeting in Septem ber, 1983. The aim of making new, even extravagant ideas palatable to each other was well accomplished by the participants. We trust that some of the ensuing excitement has been carried over into the printed version."

In the past, CT was the first choice among diagnostic measures for neurological diseases, and MRI was con- sidered to be a supplementary test. However, with the introduction of an ever increasing number of devices, MRI is being used routinely, and it is possible that eventually CT will become supplementary to MRI. This guide to the practical use of MRI has been compiled bearing these considerations in mind. Minimal working knowledge of the simple operations - that does not require details about the technical production of television images - is all that is required in order to obtain information from the views. Thus, even if a clinician is not thoroughly familiar with the theories of MRI, he can use it as efficiently as he does the CT scan. In this book, the theoretical aspects of the principles of MRI are deliberately simplified and the text can be used solely as an atlas. In the introduction, useful general features of MRI interpretation are described and itemized, and major diseases of the central nervous system are presented.

A quarter of a century has elapsed since Nils Lundberg published his thesis "Continuous Recording and Control of Ventricular Fluid Pressure In Neurosurgical Practice." This publication, more than any other, propelled continuous monitoring of intracranial pressure from the status of a research tool to become an integral part of neurosurgical intensive care, with wide application in the management of patients with head injuries, intracranial haemorrhage, brain tumours and disorders of the CSF circulation. At the same time, experimental studies by Langfitt and others stimulated investigations of the relationships between intracranial pressure and cerebral blood flow, intracranial pressure volume relationships and studies of the formation and absorption of CSF. By 1972, Mario Brock had realised the extent of the interest in intracranial pressure research and organised the First International Symposium on Intracranial Pressure in Hanover in that year. This was the start of a series of highly successful meetings, subsequently held in Lund (1974), Groningen (1976), Williamsburg (1979) and Tokyo (1982), the proceed ings of which have been published as a uniform series of books. In each of these volumes the up to date status of research and clinical application of intracranial pressure measurement has been presented in a concise yet comprehensive way. The present volume contains the proceedings of the Sixth International Intracranial Pressure Symposium that was held in Glasgow, Scottland, from June 9th to 13th, 1985."

Radiosurgery is a rapidly developing form of minimally invasive neurosurgery. Selected papers from the first meeting of the International Stereotactic Radiosurgery Society in Stockholm, June 1993, reflect current multidisciplinary approaches to difficult intracranial neurosurgical problems. Neurosurgeons, radiotherapists, oncologists, radiobiologists, physicists and representatives of several other clinical disciplines inform about the state-of-the-art of radiosurgical treatment of a multitude of intracranial problems such as arteriovenous malformations, pituitary and pineal tumors, vestibular schwannomas as well as metastatic brain tumors and gliomas.

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, 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 suc cessfully bring to the attention of physicians within developing spe cialties what is occurring, but generally only in demonstration form without providing historical perspective, pathoanatomical corre lates, 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 de veloped 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 neuro in different countries throughout the world organized surgeons themselves respectively into national and international societies for pediatric neurosurgery. These events were both preceded and fol lowed 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."

In this age when we are witnessing a veritable explosion in new modalities in diagnos tic imaging we continue to have a great need for detailed studies of the vascularity of the brain in patients who have all types of cerebral vascular disease. Much of the understanding of cerebral vascular occlusive lesions which we developed in the last two decades was based on our ability to demonstrate the vessels that were affected. Much experimental work in animals had been done where major cerebral vessels were obstructed and the effects of these obstructions on the brain observed pathologically. However, it was not until cerebral angiography could be performed with the detail that became possible in the decades of the '60 's and subsequently that we could begin to understand the relationship of the obstructed vessels observed angiographically to the clinical findings. In addition, much physiologic information was obtained. For instance, the concept ofluxury perfusion which is used to describe non-nutritional flow through the tissues was observed first angiographically although the term was not used until LASSEN described it as a pathophysiological phenomenon observed during cerebral blood flow studies with radioactive isotopes. The concept of embolic occlusions of the cerebral vessels as against thrombosis was clarified and the relative frequency of thrombosis versus embolism was better understood. The concept of collateral circulation of the brain through so-called meningeal end-to end arterial anastomoses was vastly better understood when serial angiography in obstructive cerebral vascular disease was carried out with increasing frequency."

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."

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."

This volume is dedicated to the Third International Symposium on Microneurosurgical Anastomoses for Cerebral Ischemia, which took place in Rottach-Egern, June 2&-30, 1976, under the sponsorship of Professor F. Marguth, Director of the Depart- ment of Neurosurgery, Ludwig-Maximilians-University of Munich (West Germany). It contains the continuing devel- opments of the extra- intracranial arterial bypass (EIAB) for cerebrovascular occlusive disease since the First International Symposium in Lorna Linda, California, in June, 1973, and the Second International Symposium in Chicago, Illinois, in June, 1974. The EIAB was developed by Donaghy and Yasargil, and it consists of a microsurgical anastomosis of the superficial tem- poral artery or the occipi tal branch of the external carotid artery to the middle cerebral artery on the surface of the brain and, very recently, the anastomosis of the occipital artery to the posterior-inferior cerebellar artery for the treatment of verte- brobasilar insufficiency. From the presentations at the sym- posium it became evident that the greatest potential in the pre- vention of a stroke in a susceptible patient is the presence of an adequate collateral cerebral blood flow. The basic diagnostic procedure is cerebral angiography in- cluding both carotid and vertebral arteries. Regional cerebral blood flow (rCBF) studies and computerized tomography add further diagnostic information and are particularly important in the selection of potential surgical candidates.

Benefits: - Leblancs new investigative technique allows the rapid visualisation of the most vulnerable points of the cranial nerves - the course of each nerve is studied radiologically and anatomically, using dissections, injections, serial macroscopic sections, and x-rays - each cranial nerve is depicted from its origin to the muscle with its intracranial, extracranial, and intracranial pathways - the start of each chapter features an illustration of the cranial nerve as a whole, allowing the reader to quickly memorize the cranial anatomy - unique full-colour illustrations make the atlas a reference of outstanding value to clinicians, researchers and students

Georg Rodewald University of Hamburg Hamburg, Federal Republic of Germany Allen E. Willner Hillside Hospital Glen Oaks, NY In contrast to the initial years of cardiac surgery (37 years ago), there is now increasing interest in cerebral protection. Rodewald [1] in 1978 was among the first to point out the surgeon's concern with "psychopathological problems" and Taylor [2] in 1989 stressed that" *** the awareness of the cerebral consequences of open heart surgery has risen considerably in recent years * * * " This book reviews the evidence for neurological, psychological, and neuropsycho logical reactions to cardiac surgery. In previous studies one problem is that small samples of patients were studied with different measuring instruments so that it was difficult to ma~e sense of inconsistent findings. Considerable controversy resulted with little ability to sort out discrepant findings. It appeared that a large multi center study using uniform measures might help clarify the picture.

Language and Speech has been selected for the Fifth Convention of the Academia Eurasiana Neurochirurgica as a topic closely related to neurosurgery but also to philosophy, art, culture and humanity and treated by various experts of the field of this interdisciplinary subject. The volume has a certain structure: Language is evaluated as a tool of the Homo Artis in the introduction, which is followed by chapters focusing the language in history, in linguistics, as well as in music and that of the animals. In the next part speech is dealt with as a physiological process. It is followed by papers on three different but uniformly neurosurgical representation of speech in gliomas, AVMs, and focal epilepsies. Neurologists compiled papers on clinical forms of aphasia, and that among bilinguists as well as on lateralisation of speech centres in relation of handedness followed by rehabilitation of speech disorders. Two papers on language and computers complete the volume.

Surgical Techniques in Epilepsy Surgery presents the operative procedures used in the treatment of intractable epilepsy in a practical, clinically relevant manner. Founded by pioneering neurosurgeon Wilder Penfield, the Montreal Neurological Institute (MNI) is a leading global centre of epilepsy surgery and this volume reflects the Institute's approach, combining traditional techniques with modern neuronavigation based approaches. There is an emphasis on mastering the important trilogy of topographic, vascular and functional anatomy of the brain. The basic anatomical and physiological mechanisms underlying epilepsy are presented in a practical manner, along with the clinical seizure evaluation that leads to a surgical hypothesis. The consultation skills and investigations necessary for appropriate patient selection are discussed, as well as pitfalls and the avoidance of complications. This is an invaluable resource not only for neurosurgeons, neurosurgical residents and fellows in epilepsy surgery, but also for neurologists, and others who provide medical care for patients with intractable epilepsy.

This book is devoted to the description of agenesis of the corpus callosum, a congenital malformation of midline structures in the brain that may be regarded as a natural model of the "split-brain. " First reported by Rei! in 1812, this anomaly has since been described by several investigators. Interest in this malformation was revived in the 1970s by studies of interhemispheric transfer in Bogen and Vogel's commissurotomized patients and the subsequent findings by Sperry that acallosal patients were devoid of the typical disconnection deficits found in patients with surgical transection of the corpus callosum. Since this seminal work, the bulk of neuropsychological research on callosal agenesis has focused on the particulars of interhemispheric transfer and integration. An ever-growing literature has emerged on the subject, attempting to specify the extent and limits of neural plasticity in a nervous system that has evolved in the absence of the most important interhemispheric pathway. Whilst callosal agenesis proves to be an excellent model of cerebral plasticity, it has to be pointed out that this anomaly is often associated with other malformations and neurological diseases that may result in different degrees of mental retardation or other cognitive and sensorimotor deficits. In this context, neurological research on callosal agenesis has concentrated on the description of various syndromes associated with this pathology as well as on the attempt to specify its neurobehavioral manifestations.

In children, the central nervous system tumors complished through advances in the three main are exceeded in incidence only by leukemia and antineoplastic therapeutic modalities-surgery, are more common than any of the other malig- radiation therapy, and chemotherapy. Improve- nancies of childhood. Childhood central nervous ments in neurosurgical technique concomitant system tumors encompass a range of histo- with improvements in anesthesia and periopera- logic varieties from the histologically benign- tive supportive care have resulted in decreased appearing pilocytic astrocytoma to the extremely morbidity and mortality from neurosurgical malignant-appearing glioblastoma multiforme procedures together with an increased likelihood of accomplishing a gross total resection of and the undifferentiated primitive neuroecto- dermal tumors. Similarly, the biologic behavior tumor. Radiotherapy has evolved from using orthovoltage (200-250 KV) equipment to of childhood brain tumors varies not only ac- cording to histology but also with location of supervoltage equipment with much-improved the tumor and age. Unlike primary central nerv- penetration, thus allowing for the administra- ous system tumors in adults, many varieties of tion of accurate homogeneous high doses to childhood brain tumors have the propensity to large volumes without significant effects on the disseminate via the cerebrospinal fluid path- overlying skin and soft tissues. Preliminary data ways.

Gliomas, which comprise astrocytic, oligodendroglial, and ependymal lesions, are the most frequent primary intracranial tumors. This volume summarizes the enormous advances in our knowledge of gliomas that have occurred during recent years. The first part of the book focuses on the glial tumor entities, with detailed discussion of diagnosis, molecular genetics, and tumor origin. This section also contains a chapter on hereditary tumor syndromes associated with gliomas and the molecular mechanisms underlying these specific diseases. The second part is devoted to the clinical management of gliomas and provides insights into novel developments regarding neuroimaging, surgical management, radiation therapy, adjuvant therapy, experimental approaches, and the neurotoxicity of treatment. The final part of the book addresses angiogenesis and epigenetic regulation of gene expression in gliomas.

Endovascular Interventional Neuroradiology is comprised of selected papers from the prestigious "Stonwin Medical" "Conference," which each summer invites a group of internationally prominent neuroscientists, bioengineers, neurosurgeons, and radiologists to explore and discuss selected topics of neurosurgical investigation. This volume addresses recent advances in endovascular approaches to cerebral circulation, including: Surgical exposure of the superior ophthalmic vein in the management of carotid cavernous fistulas at Johns Hopkins; Current and future perspectives in interventional neuroradiology at New York University; Interventional neuroradiology; Principles of endovascular neurosurgery: N.N. Burdenko Neurosurgical Institute; Intravascular embolization of craniocerebral vascular diseases: Beijing Neurosurgical Institute; and more.

The last ten years has witnessed a resurgence of interest in stereotactic surgery although this has been mainly in the field of the comparatively simple stereotactic biopsy of intracranial tumours. There is also evidence of a returning interest in functional neurosurgery other than pain which has always sustained high levels of endeavour. The present work comprises selected papers from a much larger group of interesting and important communications to the European Society for Stereotactic and Functional Neurosurgery. They represent modern views on a wide variety of stereotactic surgical topics from internationally acclaimed experts in this field. The neurosurgeon who has little or no acquaintance with this fruitful sub-specialty will be surprised to find very broad applications of the technique which is gradually replacing many con ventional neurosurgical procedures. This is particularly evident in the papers on tumours but there is also a section on the treatment of vascular disease which marks an extension of neurosurgical practice. The Society has always regarded technical advances as important and some of the most recent devel opments appear in this book. Finally, an exciting new development of neural transplantation marks the beginning of what may be an important part of neurological surgery in the future."

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

From its discovery in 1929 by Hans Berger until the late 1960s, when sensory visual and auditory evoked potentials were dis covered and became popular, the EEG was the most important method of neurophysiological examination. W-ith the advent of computer technology in the 1980s, it became possible to plot the potential fields of the EEG onto models of the scalp. This plot ting of information as neuroimages followed the structural and functional techniques of Cf, MRI, PET and SPECf. The success of this method, which began in the early 1980s, has led to the brain mapping of EEGs and EPs being increasingly used for di agnosistic purposes in neurology, psychiatry and psychopharma cology. The pioneers of this method believed in it and were commit ted to its success. However, many traditionalists felt that it gave no new information and so regarded the method with scepticism. Some found both the coloured maps and the mapping technique misleading, which led to unnecessary conflict between mappers and their chromophobic oponents. Emotions have run so high that some professional bodies have justifiably adopted guidelines and warned of the misuse of the method."

Severe head injuries are a frequent occurrence in the life of every emergency care specialist, traumatologist, neurosurgeon, and rehabilitation specialist. For example, between 30.000 to 40.000 severe head injuries occur in Germany each year. Over 75.000 Americans die each year after having suffered a severe head injury. Nevertheless, treatment is not always optimal. Survival and longterm outcome depends not only on the type of injury but also on timely and appropriate diagnosis and treatment. Thus, all physicians involved must be aware of the current procedures in the management of severe head injuries. This reference book, based on the experience of international experts, provides an up to date and practical guideline.

Monitoring of Cerebral and Spinal Haemodynamics During Neurosurgery is a comprehensive description of subdural monitoring of intracranial pressure (ICP) during neurosurgery. It offers thorough analysis of a comprehensive database consisting of measurements of ICP, cerebral perfusion pressure and other relevant physiological data from more than 1,800 patients subjected to intracranial surgery at Aarhus University Hospital. Features of anaesthesia, both inhalation and total intravenous, are discussed, and measures to reduce ICP are described. A majority of the patients had supratentorial tumours, but the database also includes patients with infratentorial tumours and patients with no intracranial space-occupying lesions. A chapter is reserved for discussion of the special features of children with cerebral tumours.

This comprehensive volume is the current final word on the subject. It contains more than 90 papers, giving a summary of clinical and basic studies on cerebral vasospasm. It includes reviews by leading researchers in the field. Several new subjects are proposed for future research that will not only promote research from neurosurgery and neurology but also from other interconnecting fields of emergency medicine, electrophysiology, molecular biology, and vascular biology.