''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

In 1992 the Editors published the first volume of Minimally Invasive Neurosurgery (MIN I) which described the current state of the art in this rapidly developing field of neurosurgery and reported first clinical experiences with these new technologies. The subject of MIN II is limited to endoscopic anatomy, technical devices and surgical management of disorders suitable for endoscopic procedures. The indications and approaches in different diseases are still highly preliminary and longterm results are not yet available. The clinical value and the benefit to the patients treated with these new techniques must still be proven against the well established standards of microsurgery. This volume presents a critical update of neuroendoscopy.

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.

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."

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."

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."

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

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

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

2 3 4 5 6 7 8 9 1011 1 2 3 4111 This book provides coverage of a broad range of topics in the ?eld of neurosurgery, 5 for residents and registrars in training and for recent graduates of training programs. 6 As neurosurgical training incorporates expertise from centers worldwide, there is a 7 need to have input from specialists in neurosurgery from various countries. This text 8 is a compilation by expert authors in the USA and the UK to provide information on 9 the basic knowledge and clinical management required for optimal care of neuro- 2011 surgical patients. 1 The text is an up-to-date synopsis of the ?eld of neurosurgery from American and 2 British perspectives, which covers the most common clinical conditions encountered 3 by neurosurgeons. The chapters are organized under broad topics, including inves- 4 tigative studies, perioperative care, the role of newer techniques and the management 5 of tumors, vascular and traumatic lesions. Additional topics are then covered, includ- 6 ing pediatrics, spine and peripheral nerve lesions, as well as functional neurosurgery 7 and infections. We anticipate that trainees will ?nd this information useful for certi?- 8 cation examinations and recent graduates of neurosurgical training programs can 9 utilize this text as an update of the most important neurosurgical topics.

Recent radiologic procedures in bone and joints, some of which eliminate the need for surgery are exposed, including: trephine biopsies of the thoracic and lumbar spine, sacro-iliac joints, peripheral bones synovial membrane and soft tissues, using either fluoroscopic echographic or CT guidance - chemonucleolysis - vascular embolization of skeletal tumors and management of vertebral hemangiomas - selective steroid injection in a broad spectrum of diseases including vertebral facet syndrom, cervicobrachial nerve root pain, rotator cuff calcium deposits, bone cysts. This unique volume supplies the reader with complete information regarding the performance of all these techniques.

The death 'Of a child, 'One wh'Ose vulnerability and unfilled promise c'Omp'Ounds the tragedy 'Of any death, t'Ouches us deeply. When that death 'Occurs due t'O the generally unexpected and sudden loss 'Of brain functi'On, it is particularly P'Oignant. And yet, when death c'Omes, it sh'Ould be diag- nosed expediti'Ously. The professi'Onal resP'Onsibilities 'Of the physician require that he b'Oth rec- 'Ognize brain death and inf'Orm the family 'Of its occurrence. In additi'On, since recent advances in transplantati'On provide the P'Ossibility 'Of using the 'Organs 'Of a brain-dead child t'O save the lives 'Of 'Other children, the c'Oncepts 'Of beneficence an~ charity further c'Ompel physicians t'O facilitate such transplantati'Ons by inf'Orming the family about this P'Ossibility. Criteria 'Of brain death have been refined 'Over about 30 years since the term coma depasse (bey'Ond c'Oma) was coined by M'Ollaret and G'Oulon in 1957 (Kaufman and Lynn, 1986). The last maj'Or criteria ev'Olved 'On a nati'Onal level were th'Ose 'Of the President's C'Ommissi'On in 1981. H'Owever, studies t'O date have c'Oncentrated 'On adults, and relatively little work has been rep'Orted ab'Out devel'Oping brain death criteria f'Or the y'Oung. Indeed, the advis'Ors t'O the President's Com- missi'On suggested that there are significant-although n'Ot well defined~ifferences in the ability of the brains 'Of th'Ose under five years 'Of age t'O rec'Over from clinical states that W'Ould be accepted as indicative 'Of c'Omplete and irreversible l'OSS of brain functi'On in adults.

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.

The sellar region and paranasal sinuses constitute the anatomical sections of the skull base in which pathological entities warrant interdisciplinary management. Processes originating in the paranasal sinuses can reach and involve the skull base in and around the sella, sometimes not respecting the natural dural boundary. On the other hand, lesions involving the sellar block, such as pituitary adenomas and meningiomas, can also extend downwards into the paranasal sinuses. The orbit and cavernous sinus may be subject to involvement and infiltration by both paranasal and sellar pathology. The advancement and new achievements of modern diagnostic procedures, such as high-resolution CT, three-dimensional reconstruc tion, MRI, and MRI angiography, as well as the detailed selective angiographic protocols and endovascular techniques, have increased the possibilities for surgical management of this type of pathology with extra- and intracranial involvement. Long-standing and intense inter disciplinary work has led to sophisticated operative approaches which for benign tumors allow total excision with preservation of structures and function, and for some malignant lesions permit an en bloc resec tion via a combined intracranial-extracranial approach. This volume reflects the work and scientific exchange which took place during the IV International Congress of the Skull Base Study Group, held in Hanover. Leading authorities in the basic sciences including anatomy joined with diagnosticians, clinicians, and surgeons from different fields to evaluate the state of the art of this topic in skull base surgery."

The presence of sophisticated auditory processing in mammals has permitted perhaps the most significant evolutionary development in humans: that of language. An understanding of the neural basis of hearing is thus a starting point for elucidating the mechanisms that are essential to human communication. The cochlear nucleus is the first region of the brain to receive input from the inner ear and is therefore the earliest stage in the central nervous system at which auditory signals are processed for distribution to higher centers. Clarifying its role in the central auditory pathway is crucial to our knowledge of how the brain deals with complex stimuli such as speech, and is also essential for understanding the central effects of peripheral sensorineural hearing loss caused by, for example, aging, ototoxic drugs, and noise. Ambitious new developments to assist people with total sensorineural deafness, including both cochlear and cochleus nuclear implants, require a detailed knowledge of the neural signals received by the brainstem and how these are processed. Recently, many new data have been obtained on the structure and function of the cochlear nucleus utilizing combinations of anatomical, physiological, pharmacological and molecular biological procedures. Approaches such as intracellular dye-filling of physiologically identified neurons, localization of classical neurotransmitters, peptides, receptors and special proteins, or gene expression have opened the door to novel morphofunctional correlations.

It is, of course, a real challenge to summon together an International Sym- posium in and around the Brain Stem and Third Ventricle. Up to this mo- ment the various experiences and papers on this subject were distributed throughout the world literature, making it very difficult for someone in- terested in the matter to have access to the actual state of knowledge. Therefore I believe such a meeting was long overdue and is a considerable attempt to open closed doors for present and future ambitious neurosurgi- cal activities. After succeeding in previous symposiums of similar interest in Hanno- ver, it was obvious that Prof. Madjid Samii and his coworkers took the in- itiative of organizing such a meeting, bringing together - in the pure sense of the word - Neurosurgeons with Anatomists, Neurologists, Neuro- physiologists, Neuroradiologists, ENT-, Maxillofacial-, Stereotactic-, and Radiosurgeons as well as other colleagues. One contribution after the other followed, from the basic sciences up to the operative management con- sidering very new and actual concepts. Through the application of new microsurgical techniques and the incorporation of new understanding for the many problems afflicting the midline of the eNS, and based on a growing closer cooperation between the various disciplines, a wide field has opened up which concerns us all.

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."

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."

Malignant glioma is generally considered one of the most therapeutically difficult cerebral tumors. This book deals with many aspects of gliomas, including factors related to incidence and epidemiology, and surveys the history of glioma therapies. Experimental studies carried out by the Sendai Group of Neurosurgeons are reported, together with the results of many clinical studies of RAFP therapy. This particular theorapy involves the administration of radiation treatment and three chemical compounds: ACNU, Futraful and PSK. A recent technique for evaluating the effectiveness of therapy based on MRI diagnostic methods is introduced. This book thus offers valuable information and guidelines for future developments in treatment.

Memory is essential for the retention of learning. In the presence of memory deficits, new learning is impaired and performance of previously learned habits deteriorates. What is the nature of memory? Where does it reside in the brain? What biological events are associated with the formation and retrieval of memory? These questions are explored in the first chapter of this volume. The answers are not final, but we have learned a great deal about memory processes during the past few decades. Memory is influenced by most of the pathological processes that influ ence the brain such as infection, trauma, cerebrovascular disorders, and met abolic and degenerative diseases. The nature and course of memory impairment are unique for each of the disorders and are fairly distinguishable. More than fifty conditions are known to cause dementia, which now affects several million Americans. In Alzheimer's disease, memory disorder predominates for two to three years before other intellectual functions are affected. Many neurological diseases, such as Huntington's disease, Friedreich's ataxia, and multiple sclerosis, are associated with progressive memory deficits. Forgetting is a problem that becomes progressively worse with age. Most individuals in their forties begin to experience some difficulty in quick recall of past events. By age sixty definite changes are evident in the process of registration, storage, and recall of memory. At this age the material that is to be remembered is processed more slowly, stored less firmly, and poorly recalled."

Progress in traumatology of the vertebral spine has been restrained for a long time by two hindering factors. The first obstacle is presented by the differences in approach and a conflict of competences. The neurosurgeons, considering only the spinal chord, have confined themselves to indications for laminectomy, an insufficient and usually ineffective intervention. The orthopedic surgeons, on the other hand, obsessed by the fear of medullary lesions, have long hesitated to apply the fundamental rules for the treatment of fractures, namely precise reduction followed by strict immobilization, thus depriving themselves of the efficacy of radiculomedul lar decompression and of the protection this procedure affords to these structures when they are themselves involved in the trauma. Taking these facts into account, together with the rather poor results of laminectomy, the specialists have wisely and successfully recommended that one should abstain from treating the initial lesion, but rather attenuate the damage by appropiate nursing care and adequate reeducation. The second hindering factor was the insufficient knowledge of the extreme complexity of the anatomic lesions. This explains the orthopedists' relative caution; one only treats well what one knows well. More precise analysis of the lesions, not only of the bones but also of the joints, i. e., the osteofibrous involvement, is mainly based on strict radiologic semiology, which is rendered difficult because these structures are simultaneously affected. We are greatly indebted to Dr. DOSCH, radiologist at our Center, for having untertaken this difficult task, using all available conventional radiologic techniques."

Abundantly illustrated with more than 1,850 figures, this comprehensive monograph describes the experience gained through the treatment of patients with spinal tumors over a 25-year period. It covers clinical presentations and neuroradiological features of intramedullary, extramedullary, and extradural spinal tumors. Coverage provides step-by-step intraoperative photographs to describe surgical strategies. In addition, the book offers techniques and gives detailed statistical analyses on postoperative outcomes by focusing on postoperative complications as well as short-term and long-term results.

The second common meeting of the European Section and the Cervical Spine Research Society took place in Marseille (France) from June 12 to 15, 1988 and was organized by Rene Louis. More than 130 specialists from every part of Europe, from America and Asia participated, representing, among others, the fields of Orthopedics, Neurosurgery, Traumatology, Neurology, Anatomy, Rheumatology and Radiology. This meeting again was convincing proof of the growing interest which exists in Europe in research into injuries and diseases of the cervical spine. The main topics of this meeting were the subluxation of the lower cervical spine (chapter 1) and the infectious diseases of the cervical spine (chapter 2). Chapters 3 and 4 of this volume deal with degenerative lesions and the upper cervical spine. In chapter 5 experimental reports are presented, so that a good synopsis is provided of our present state of knowledge of diseases of the cervical spine. The European Section of the Cervical Spine Research Society was founded by Mario Boni in 1984, who unfortunately died in 1986 and was proclaimed Honory President of the European Section. There is a European meeting every summer and one every three years with our colleagues from the United States of America, Canada and Japan organized in Europe. The first combined meeting was organized by Pierre Kehr in Strasbourg (France) in 1985 and the presented papers were published in Cervical Spine I (Springer, Wien-New York, 1987).

Statistically speaking, head and neck cancer per se (excluding melano ma and basal cell carcinoma) does not outwardly seem to pose a serious threat - 27,500/870,000 total cancer cases estimated for 1984 (or 3.2% of all cancers) and 9,350/450,000 total cancer deaths in 1984 (or 2.1 %) for the United States. Yet in clinical practice, by the time that diagnosis is made, more than 60% of oral cancers have already spread to the nearby lymph node system. And while the overall five-year survival rate for localized oral cancer is 67%, this rate decreases drastically to only 25% when the original cancer has metastasized. Scientific textbooks all too often are merely a compilation of dis crete parts, rather than a correlated, integrated whole. Dr. Hamner and his colleagues have achieved such an integrated, succinct version in The Management of Head and Neck Cancer. The outstanding group of contributors bring to the book a wealth of accumulated knowledge and expertise in their various cancer spe cialty disciplines. They are associated with some of the most distin guished cancer centers in the United States.

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

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.

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.