This volume is a compilation of papers presented at the Tenth International Symposium on Brain Edema held on October 20-23, 1996, in San Diego, California. This follows the sequence of meetings that was initiated 31 years ago in the First International Symposium held in Vienna. Subsequent symposiums were held in Mainz, Montreal, Berlin, Groningen, Tokyo, Baltimore, Bern, and Tokyo CY okohama). A considerable number of papers was chosen from over 100 papers that were received. The organizers wish to thank the Advisory Committee for the excellent work done in selection of the papers. We also wish to thank all the persons who contributed to the success of the Tenth International Symposium, especially the staff who worked behind the scenes. These papers were reviewed, edited, approved or disapproved by the Editorial Board. Those manuscripts that were felt not pertinent to this publication were not accepted by the Editorial Board. Therefore, the excellent quality of those that are in the book are a reflection of the authors' dedication and work and that of those of the Editorial Board in their review process. For the reader's convenience, the papers are structured according to the various disease processes which are associated with the primary topic: hypertension, hydrocephalus, infection, ischemia, tumor, etc. We do hope that the reader will enjoy the articles and that they will provide an impetus and insight for future work.

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.

The cerebello-pontine angle has always posed a challenge to the neurosurgeon, the otoneurosurgeon, and the neuroradiologist. Angle masses which are very small and difficult to detect frequently produce symptoms, but may remain silent while growing to exceptional size. The neuroradiologist must have firm knowl edge of the clinical manifestations of the diverse angle lesions in order to tailor his studies to the patients' needs. The majority of angle lesions are benign; thus successful surgery has the potential for complete cure. Angle lesions typically arise in conjunction with vital neurovascular structures, and often displace these away from their expected positions. Large lesions may attenuate the vestibulocochlear and facial nerves and thin them over their dome. Since the nerves often remain functional, the surgeon then faces the need to separate the tumor from the contiguous nerve, with preservation of neurological function. Depending on the exact location and extension of the lesion, resection may best be attempted via otologic or neurosurgical approaches. The neuroradiologist must determine - precisely -the presence, site, size, and extension( s) of the lesion and the displacement of vital neurovascular structures as a guide to selecting the line of surgical attack. Since the arteries, veins, and nerves that traverse the angle are fine structures, the neuroradiologist must perform studies of the highest quality to do his job effectively."

The two International Symposia on Spinal Cord Monitoring, held in Tokyo in 1981 [Homma S, Tamaki T (eds) (1984) Fundamentals and clinical appli- cation of spinal cord monitoring. Saikon Publishing, Tokyo] and Erlangen in 1984, were remarkable in that they stimulated a gathering of electro- encephalographic, neurophysiological, orthopaedic, neurosurgical, anaes- thetic and pathological practitioners, presenting experimental, clinical and surgical experiences. The factor held in common was an understanding of the need to reduce the incidence and severity of iatrogenic neurological im- pairment associated with certain surgical and radiographic procedures. In the past there has been a tendency for the study of human evoked poten- tials (EPs) to be regarded as an end in itself, or at best a discipline which can be of limited assistance in certain problems of neurological diagnosis. Symposia such as these serve the valuable function of opening electro- physiological eyes to the problems to which EP techniques might usefully be devoted in other medical spheres. They also help those who practise electrophysiology as an adjunct to their speciality to comprehend such of the more complex properties of EPs as are relevant to their particular interests. The title of the Symposia and of this volume arose as a result of an his- torical accident. The pioneers of intraoperative neuronal monitoring were mostly surgeons specialising in the correction of spinal deformities or the removal of tumours.

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

Ever since I began my training in internaI medicine and subsequently in neurology, I have been interested in subarachnoid haemorrhage and indeed chose this topic as a subject of study for my Doctorate in Medicine. It was because the information derived from a retrospective study of 312 patients proved to be so interesting that I published a monograph on the subject 30 years ago. My first reaction on reading this splendid book by my former coHeagues in Newcastle, Mr. Sengupta and Dr. McAllister, was one of realisation of the extent to whjch knowledge about the condition' and principles of management have been transformed. This splendidly comprehensive volume carefully reviews the earlier literature, analyses the anato micaI, pathophysiologicaI and clinical features of the condition in consummate detail and goes on to consider in depth all of those issues relating to investigation and medical and surgical management which continue to present chaHenges to neurologists and neuro-surgeons alike. When I began my personal study, angiography had still to be introduced as a routine method of radiologicaI diagnosis in many centres in the U .K. and we were Iargely dependent upon dinicaI methods of diagnosis and assessment. How interesting it is to see that now, very properly, computerised tomography (CT scanning) takes precedence as an initiaI diagnostic instrument over angiography, and that lumbar puncture, once thought to be obligatory for diagnosis, is being used Iess and less since its dangers were fully appreciated."

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.

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."

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."

The question facing anyone contemplating a book on low back pain is: Why write another book? It is certainly true that there are many books on this topic addressing a wide variety of audiences. Some books are all inclusive and scholarly in nature, others are personal descriptions of diagnostic and treat ment philosophies. This book is a combination of these two extremes. It represents our views on the low back problem, supported by scientific data. Most aspects on back pain presented in this book can be found in other texts. The organization of the material is unique, however. Our approach is to start by listening to and looking at the patient. It becomes apparent, then, that patients can be classified into one of the syn dromes described in chapters 4 through 13. We believe that this syndrome classification, which is quite simple to make clinically, will allow you to diagnose and treat your patients more effectively. To set the stage for the syndrome chapters the first three chapters of the book are generic to the remaining chapters. They reviewe the epidemiology, pathology, biomechan ics, etiologic theory, diagnostic methods, and treatment modalities applicable to the low back syndromes. They should be read before the syndrome chap ters. At the end of the book you will find four chapters that are specific to disease entities."

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."

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."

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."

The Omentum explores and assesses the comparatively new approach of using omental attachment in the treatment of a variety of neurologic diseases. Topics discussed include historical images and ideas connected with the greater omentum; angiogenesis and the greater omentum; implications for central nervous system injury of vasoactive chemicals in the omentum; effects of omental-derived lipid fractions on osseous vascularization and bone formation; cerebral revascularization by omental graft for moyamoya disease; omental transposition for treating the sequelae of viral encephalitis; experimental and clinical use of omental transposition for spinal cord pathology; and lumbo-omental shunt for treatment of communicating hydrocephalus. The effect of omentum transposition to the brain on regional cerebral blood flow in stroke patients and on delivery of chemotherapeutic agents to malignant brain tumors is also considered.

No other book covers as extensively all aspects of peripheral nerve surgery. This includes the pathology and pathophysiology of compression neuropathies, traumatic nerve lesions and nerve tumours, and their treatment with various techniques. All body regions are described adequately. The second part of the book deals with palliative surgery for reconstruction of lost function. This includes a comprehensive array of muscle and tendon transfers, functional muscle transplantation and intramuscular neurotisation.

''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

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.

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."

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.

'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."

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.

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).

This volume contains 93 papers from internationally recognized experts in the field of brain edema and brain injury. The papers include human and animal studies on edema following stroke, cerebral hemorrhage, traumatic brain injury, spinal cord injury and hydrocephalus. Papers also address fluid dynamics in the brain (including the role of aquaporins).