An International Conference on "Neurosurgical Training and Reserach" was held in Munich from October 6 - 9, 1996, under the auspices of the EANS, and organized by H.-J. Reulen and H.-J. Steiger. Experts from different countries and neurosurgical organizations have collected information on the present status of resident training in neurosurgery and the mechanisms involved with the training. Various aspects, the recruitment process, the criteria used for selection, the contents and structure of a program, the continuous quality control, exposition to the art of research, fellowships and subspeciality training, etc. have been covered. The present book contains this material and thus provides a unique and comprehensive source of information on the complex of modern neurosurgical training. " ... The beauty of this work is that it puts in one place the many varied aspects of a neurosurgical training program that one needs to be aware of ... should be required reading for the faculty of any academic training program as well as for others who may have a misconception of what residency training is ... an excellent book for any program director or active faculty member. It should be required reading for all faculty members before the next round of resident interviews ..." Neurosurgery "... well edited, published to a high standard and will naturally be of interest to those specifically involved in the areas of selection and training ... a useful text for aspirants to surgical training posts ..." British Journal of Neurosurgery

Evidence-based Clinical Practice (EBCP) is the conscientious, explicit, and judicious use of current best external evidence in making decisions about the care of individual patients. In neurology, practice has shifted from a rich, descriptive discipline to one of increasingly diagnostic and therapeutic interventions. Providing a comprehensive review of the current best evidence, Neurology: An Evidence-Based Approach presents this type of evidence in a concise, user-friendly and easily accessible manner. The three co-editors of this important volume are linked in their passion for evidence-based clinical practice in the clinical neurological sciences, connected to a common historical origin at the University of Western Ontario (UWO), London, Ontario Canada and influenced directly by Evidence-Based Medicine teachings of McMaster University, Hamilton, Ontario Cananda. The book is organized in three sections: Basics of Evidence-Based Clinical Practice, with an introduction to the topic, a chapter on the evolution of the hierarchy of evidence, and another chapter on guidelines for rating the quality of evidence and grading the strength of recommendation. The second section, Neurological Diseases, provides an illuminating overview of evidence-based care in ten of the most common areas in neurologic practice. The final, third section provides an outstanding roadmap for teaching evidence-based neurology with a chapter on the Evidence-Based Curriculum. A superb contribution to the literature, Neurology: An Evidence-Based Approach offers a well designed, well written, practical reference for all providers and researchers interested in the evidence-based practice of neurology.

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

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."

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series devoted to Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume. Our series is not intended to compete with the puhlicationR of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume. In the second part of each volume, we publish detailed descriptions of standard operative procedures, furnished by experienced clinicians; in these articles the authors describe the techniques they employ and explain the advantages, difficulties and risks involved in the various procedures. This part is intended primarily to assist young neurosurgeons in their postgraduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons.

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."

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.

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."

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series of Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. This series was first discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathers of the series being Jean Brihaye, Bernard Pertuiset, Fritz Loew and Hugo Krayenbiihl. Thus were established the principles of European co operation which have been born from the European spirit, flourished in the European Association, and have throughout been associated with this series. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by spe cialists in the given fields and constitute the first part of each volume."

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series devoted to Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume. In the second part of each volume, we publish detailed descriptions of standard operative procedures, furnished by experienced clinicians; in these articles the authors describe the techniques they employ and explain the advantages, difficulties and risks involved in the various procedures. This part is intended primarily to assist young neurosurgeons in their post graduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons."

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."

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series devoted to Advances and Technical Standards in Neurosurgery which was later sponsored by the Euro pean Association of Neurosurgical Societies. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume. In the second part of each volume, we publish detailed descriptions of standard operative procedures, furnished by experienced clinicians; in these articles the authors describe the techniques they employ and explain the advantages, difficulties and risks involved in the various procedures. This part is intended primarily to assist young neurosurgeons in their postgraduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons."

''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.

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."

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

For centuries the great minds of medical science puzzled over the importance of the cerebrospinal fluid. As far back as Hippocrates, it was thought that this "phlegm" that flooded the intracranial contents had pathological significance. However, not until the late 1800s, when Quincke introduced and popularized lumbar puncture, did physicians take an interest in the study of this fluid in relation to clinical illness. Since then a variety of techniques for obtaining cerebrospinal fluid from various sites have developed, and the relationship of cerebrospinal fluid to a variety of disease processes has received considerable study. In this volume, we have attempted to assemble reviews of some of these important developments during the past century. Chapter 1 contains a historical review of key investigations that helped shape our concepts of cerebrospinal fluid from the earliest recorded description by the author of the Edwin Smith Surgical Papyrus in the seventeenth century B. C. to contemporaries such as Kabat, Glusman, and Knaub, who introduced quantitative determinations of cerebrospinal fluid gamma globulin levels. In Chapter 2 there is a description of our current understanding of the anatomical compartment for the cerebrospinal fluid and the physiology of its formation, circulation, and absorption. Dr. Richard Leech in Chapter 3 contributes a comprehensive description of the disorders associated with excessive quanti ties of cerebrospinal fluid-commonly referred to as hydrocephalus. A variety of techniques for properly collecting and evaluating cerebrospinal fluid are detailed in Chapter 4."

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."

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.

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."

The brain stem and cerebellum are structures that have fascinated and puzzled physicians, anatomists, and physio- logists for centuries. Relatively small in volume compared to the much larger and more majestic human cerebrum, and hidden away in relative obscurity in the back of the head under the protection of the bony posterior fossa and the firm dural envelope, the tentorium cerebelli, these critical neural structures defied precise study during life until very recently. Recent advances in brain and vascular imaging and improved understanding of brain-stem reflex and tract functions and their measurement by electrophysiological techniques have presented an opportunity for clinicians and researchers to better study, during life, patients with stroke and other conditions that involve the brain stem and cere- bellum. A congress was held at the Neurology Clinic of the University in Mainz, April 4-5, 1992, during which clinicians and researchers reported and discussed modern topical diagnosis of diseases of the brain stem and cere- bellum. This volume represents the edited proceedings of that congress. Early information about brain stem anatomy and func- tions came from anatomical studies by Ludwig Turk, Paul Flechsig, Rudolph von K6lliker, Karl Burdach, Vladimir Bekterew, and Benedikt Stilling, among others, all working in Germany during the middle years of the nineteenth century. Johann Reil, a German anatomist, in the begin- ning of the nineteenth century had described the structure and some functions of the cerebellum which he called the little brain ("Kleinhirn").

Distinguished medical researchers from around the world review novel neural reconstructive techniques that appear to be beneficial for Parkinson's disease and hold promise for treating Huntington's disease, pain, demyelinating diseases, and stroke. The contributors focus on those diseases for which clinical trials are either ongoing or likely to occur in the near future. Among the topics reviewed are results and rationale for some of the leading transplant programs for the treatment of Parkinson's disease, the use of PET scanning for patient evaluation, autopsy studies of transplant recipients, transplant immunology, fetal tissue transplantation for Huntington's disease, cellular transplantation for the treatment of pain and stroke, and transplantation of myelinating cells. A full discussion of the important ethical issues surrounding the use of fetal tissue for transplantation purposes is also included.

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."

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.