This book contains the papers delivered at the Fourth International Symposium on Intracranial Pressure, held at Williamsburg, Virginia, USA, June 10-14, 1979. Divided into 12 sessions, they reflect the most recent developments in areas such as head injuries, pressure volume studies, cerebrovascular complications, intracranial hemor rhage, brain edema, systemic factors and infectious processes, data recording and analysis, CSF formation and absorption, hydroce phalus, clinical aspects of ICP monitoring, anesthesia and intra cranial pressure, treatment with barbiturates and steroids, and os motherapy. The book concludes with a summary of the present state-of-the-art in the field as a whole by Dr. Langfitt. There were two innovations at this Symposium. The first of these was poster sessions, the second, breakfast seminars. This volume contains all papers read plus all those presented as posters, and for this reason contains more pages than the three previous volumes. The organizers wish to thank the Advisory Committee for the work done in paper selection and focus of the Conference. Appreciation is also given to the Chairmen and Co-chairmen of the sessions for the preparation of summary statements. Manuscript preparation was performed by Ms. Lucille Browne, and gratitude is expressed to her. The next Symposium, the Fifth International Conference on ICP, will be held in Japan in 1982. We also wish to acknowledge the technical help of Springer-Verlag and their celerity in producing this volume. The Editors VII Contents Session I. Head Injury Chairman: D. P. BECKER; Co-chairman: I. PAPO 3 Summary . . . . . . . . . . . .."

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

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

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

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.

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.

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."

For almost a century now, since Freud described the basic motivations and Pavlov the basic mechanisms of human behavior, we have had a reasonable concept of the forces that drive us. Only recently have we gained any real insight into how the brain really works to produce such behavior. The new developments in cognitive psychology and neuroscience have taught us things about the function of the brain that would have been inconceivable even ten years ago. Yet, there still remains a tremendous gap between the two studies-human behavior and brain function-a gap which often seems irrec oncilable in view of the basic differences in the methodologies and approaches of the two fields. Students of behavior are frequently disinterested in the underlying neu rophysiology while neurophysiologists tend to consider the concepts of psychiatrists and clinical psychologists too vague and theoretical to be applicable to their own more limited schemata. Several valiant attempts have been made by experimentalists to develop a theoretical context in which behavior is described, not separately from brain function but rather as its direct outgrowth. This present work is still another attempt to develop a theoretical system which, given the limitations of our present knowledge, as completely as possible, the underlying brain mechanisms that influ will describe ence and determine human behavior. The main emphasis of this work, however, will be not on normal behavior but rather on more neurotic manifestations."

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 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."

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.

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.

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.

''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

Neurointerventional Management: Diagnosis and Treatment, Second edition has been re-titled from the original Interventional Neuroradiology reflecting the revolutionary changes occurring in this rapidly advancing field. Since the publication of the first edition, interest in neurointerventional therapy has developed at an increasing pace. New device development has expanded the range of disorders amenable to neurointerventional treatment and additional emphasis is present within medical and surgical specialities on subspecialisation in neurointerventional therapy. Physicians from all specialities involved in the care of disorders of the head, neck, and central nervous system, including neurosurgery, neuroradiology and neurology, are currently specializing in neurointerventional therapy. Neurointerventional Management: Diagnosis and Treatment, Second edition is written by a panel of today's leading experts in the field of neurointerventional therapy and edited by two neuroendovascular practitioners whose training and experience represents all three major specialties involved in neurointerventional therapy. The book is intended to provide the clinical practitioner with background information and specific descriptions of the anatomy, techniques, disorders, procedures, and decisions more commonly encountered in this field. Each chapter is illustrated with scientifically concise images, depicting pertinent neuroanatomy, imaging, neuroendovascular techniques, and related procedures. The new edition includes more diagnostic aspects of cerebrovascular disease of neurointerventional interest and discusses the treatment of disorders not covered in the first edition. Nine new chapters address increased interest in the field and provide in-depth focus on a range of new topics including normal cerebrovascular variants, non-shunting cerebrovascular malformations, the endovascular aspects of cerebrovascular disease in pregnancy, neurocritical care

Carpal Tunnel Syndrome, with its surgical profile, is a must for those specialising in this condition (hand surgeons, orthopaedic surgeons, plastic surgeons, physiatrists and hand physical therapists), for both experts and newcomers to this field. For the young surgeon just starting out, the book explains the technical modalities of surgical treatment for this condition and describes alternative non-surgical procedures. It also depicts the complications that can arise in treatment. For more experienced surgeons, this book is an instrument for deepening their knowledge of this condition and its management. It can be considered a moment for reflection on a condition that is erroneously considered simple to treat and easy to resolve. The surgical chapters compare various complications as well as various conservative and rehabilitative treatment options, thus underlining that this condition must not be underestimated. Incorrect treatment can have many negative ramifications: not only that the patient is dissatisfied but it can also lead to the hand s functional loss and render the patient an invalid. This book is also intended for all physicians and medical students interested in this subject, presenting the broad range of problems caused by this condition and how best to manage them."

Although the disease is not very often, every otorhinolaryngologist will experience some patients suffering from vocal fold paralysis.

This is the first and unique book solely devoted to this topic.

Offers step-by-step descriptions and evaluations of the materials and/or methods of well-established techniques and new therapeutic options and approaches.

Written by leading experts: Blitzer is speaker of the American Academy of Otorhinolaryngology and Head and Neck Surgery (AAO-HNS); Sulica, also a speaker of the AAO-HNS, works in his department.

Vocal Fold Paralysis is a clinically useful reference for evaluation and treatment, as well as a summary of current knowledge and investigational approaches.

'Samii's Essentials in Neurosurgery' contains selected papers written by internationally recognized contributors who were trained by Professor Madjid Samii in Hannover, Germany. The main topics deal with cutting-edge technology in neurosurgery, skull-base surgery, and specific peripheral nerve, spine, and vascular surgeries. The texts and a wealth of illustrations review and reinforce guidelines on the diagnosis and management of situations that readers are likely to encounter in everyday practice. This book will be of great interest to neurosurgeons, neurologists, ENT surgeons, neuroradiologists, and neurophysiotherapists."

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.

What is arterial dissection? What is Moyamoya angiopathy? What is the state-of-the-art of AVM treatment? Readers will find answers to these questions in this book. They will also be informed about the state-of-the-art treatment in the daily stroke therapy.

This series has already become a classic. In general, one volume is published per year. The advances section presents fields of neurosurgery and related areas in which important recent progress has been made. The technical standards section features detailed descriptions of standard procedures to assist young neurosurgeons in their post-graduate training. The contributions are written by experienced clinicians and are reviewed by all members of the editorial board.

Targeted at clinicians and residents, this series has already become a classic, with one volume published each year. The Advances section presents fields of neurosurgery and related areas in which important recent progress has been made. The Technical Standards section features detailed descriptions of standard procedures to assist young neurosurgeons in their post-graduate training. The contributions have been written by experienced clinicians and are reviewed by all members of the editorial board.

This detailed atlas illustrates the anatomical structures of the upper basal cisterns, their topography and relationship to other intra- and extradural structures. The author expands his well-established efforts to convey his outstanding neuroanatomical knowledge to the basal cisterns. His famous anatomical drawings are based upon anatomical preparations, cadaver dissections and intraoperative pictures, in order to point out important aspects concerning microsurgical and endoscopic approaches to these parts of the brain.

This text is a review of current management techniques for pituitary tumors, incorporating recent advances and discussions by experienced clinicians. The use of both endocrinologists and neurosurgeons as chapter authors allows differing perspectives to be incorporated. The book is organized around individual tumor types, with additional chapter topics added for those subjects requiring special emphasis. Appropriate photographs and illustrations are incorporated as warranted.

This is the second part in a two-volume work on neuromodulation. It describes the techniques and procedures applied by direct contact with the central nervous system or cranial nerves (in order to modulate the function of neural networks) or in deeply located structures inside the nervous system (in order to alter the function on specific networks).