In June 1973, Professor George Austin invited a small group of neuroscientists from Asia, Europe, the United States, and Canada to the Loma Linda University School of Medicine in Loma Linda, California. The fundamental technique of fashioning a small vessel collateral to the brain had been pioneered by Donaghy and Yasargil 5 years before and was now gaining momentum with the increased availability of the operating microscope, fine instruments and sutures, and surgeons trained in microvascular surgery. The interchange of ideas at this first conference was magic. The handful of participants returned home stimulated with new ideas of technique, patient selection, and postoperative evaluation and resolved to meet again on a regular basis. A Second International Symposium was hosted by Howard Reichman at Loyola University in Chicago, Illinois in June of 1974; a Third Symposium at Rottach-Egern, West Germany in June of 1976 under Professor F. Marguth of the Ludwig-Maximilians-University of Munich.

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.

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

It is estimated that the functionally significant body of knowledge for a given medical specialty changes radically every 8 years. New specialties and "sub specialization" are occurring at approximately an equal rate. Historically, estab lished 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 success fully bring to the attention of physicians within developing specialties what is occurring, but generally only in demonstration 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 train ing 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 aspects of surgically treatable diseases of the child's nervous system."

No special field of surgery dealing with the cranial nerves exists today. This is not surprising in view of the characteristics of this group of morphologically and topo graphically heterogenous nerves. Morphologically we must differentiate between central nerves (I, II and VIII) and the so-called peripheral nerves (nn. III to VII and IX to XII), in which post-lesion rgeneration is quite different. Anatomo-topographi cally we must consider an intracranial and an extracranial part of each cranial nerve. For practical reasons at operation, further subdivisions of the intracranial course of cranial nerves are to be distinguished in the anterior, middle and posterior cranial fossae as well as within the petrous bone. This underscores the extensive tasks awaiting surgeons operating in the ventral part of the brain and facial skull as well as in the more dorsal part of the skull and neck. This very wide field cannot be covered by a single surgical discipline alone. In our opinion, considerable progress has been made in surgery of the cranial nerves only in recent years. This may be explained by the increased mastery of microsurgical techniques by all surgeons in terested in the surgery of the base of the skull as well as with the initiation of more interdisciplinary consultation and jointly performed operations. Possibilities of fu ture development can be discerned in the text. The base of the skull separating the extra-and intracranial part of cranial nerves should not be a barrier but a connect ing link."

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."

Understanding the structure and function of the blood-brain barrier (BBB) and recogniz ing its clinical relevance require a concert of scientific disciplines applied from a view point of integrative physiology rather than from only molecular or analytical approaches. It is this broad scope that is emphasized in this book. In my opinion, four original contributions define the field as it exists today. The first, a monograph by Broman,1 entitled The Permeability of the Cerebrospinal Vessels in Normal and Pathological Conditions, was the model for many subsequent clinical and 3 experimental studies on BBB pathology. Second, experiments by Davson, summarized in his book entitled Physiology of the Ocular and Cerebrospinal Fluids, indicated that passive entry of nonelectrolytes into brain from blood is governed largely by their lipid 4 solubility. This research supported the original suggestion by Gesell and Hertzman that cerebral membranes have the semipermeability properties of cell membranes. The modem era of the barrier was introduced with the 1965 paper by Crone,2 entitled "Facilitated transfer of glucose from blood to brain tissue. " This paper identified stereospecific, facilitated transport of glucose as part of a system of regulatory barrier properties at a time when only a barrier to passive diffusion had been contemplated. Finally, the 1967 paper by Reese and Kamovsky, 11 entitled "Fine structural localization of a blood-brain barrier to exogenous peroxidase," sited the barrier at the continuous layer of cerebrovascular endothelial cells, which are connected by tight junctions.

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."

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.

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."

This book attempts to combine many different threads into a comprehensible whole. Since the subject is the Gamma Knife and the author is a neurosurgeon, the field of clinical interest is restricted to intracranial pathology. The discipline of radiosurgery now applies to patients who may reasonably be referred by internists, neurologists, otolaryngologists, endocrinologists and several others. Some of the topics, touched upon, such as stereotaxy and the construction of a radio surgical instrument are unfamiliar to the majority of medical men. Other topics, such as those pertaining to the reactions between radiation and living tissue, are not exactly unfamiliar and yet, for most of us, they are not comfortable areas of expertise: in that we have some basic knowledge but not enough to draw conclusions and interpret. In particular, it is not easy to answer the very sensible questions that patients ask, when being considered for this particular form of treatment. The author has attempted to describe the basic relevant phenomenology in terms that should be readily understandable to a non-specialist physician. To do this, he has been heavily dependent on the expertise of a number of mathematically sophisticated collaborators, who have checked his manuscript. They are named in the acknowledgments section. The relevance of the different sections of this book will naturally be assessed differently, according to the experience and interest of the reader. To simplifY access to the information that is required, the book is divided into three main sections.

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."

There are two important reasons for publishing this new series 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 neurosurgical 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 III 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.

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."

Four years ago the first international symposium dealing with neural transplan tation was organized as a satellite conference to the annual meeting of the Society for Neuroscience in Los Angeles, California. The expanded proceed ings of that symposium were published by Springer-Verlag in 1983 in a volume entitled Neural Tissue Transplantation Research. We were sufficiently pleased with the results of that effort to organize a second satellite international sympo sium on Neural Transplantation and Regeneration in conjunction with the 13th Annual Meeting of the Society for Neuroscience in Boston in the fall of 1983. Paralleling the growing body of research dealing with various aspects of neural transplantation, the scope of this second symposium was broadened to include not only transplantation but also regeneration. Additionally, topics of clinical interest were addressed as well as issues of basic research. The promise apparent in that first conference is still seen in the second as more and more investigators apply their talents in an attempt to understand this infant field of research. The present volume represents an expanded version of the material presented at the second symposium. We wish to thank all of the contributors to the conference and to this volume for their insight and their assistance."

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

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.

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

Spinal Cord Injury or disease can happen to anyone at any time and the effects can be devastating. I found this out personally when I was thrown from the back of a pick up truck at age 15 was left paralyzed from the waist down. It was during my recuperation as a young teenager that I first gained insight into the importance of rehabilitation. My family, doctors, nurses, fellow patients and researchers who were dedicated to helping me over come my personal tragedy helped me pull through. Today, rehabilita tion medicine is taking great strides and empowering the person with the injury to take control of their future, overcome their setbacks and, through collaborative support, reach their personal goals and potential. Since 1987 the Legacy raised by my Man in Motion World Tour (24901 miles wheeled around the world March 1985-May 1987) has pro $13 million dollars to research and rehabilitation in the areas vided over of spinal cord injury. I hope that in some small way this funding has contributed to the development of the vital programmes that supported me and many others. The effects of spinal cord injury are traumatic and life-shattering and require a skilled interdisciplinary approach. I congratulate those who have contributed to this book and challenge each one of you to never give up on your dreams to find the answers to the optimum treatment of spinal cord injury and disease."

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 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."

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."

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.

Spinal Fusion: Science and Technique puts the experience of top professionals into your own hands. Drs. Jerome M. Cotler and Howard B. Cotler and their impressive group of contributors, including researchers, educators, and clinicians, have joined together to bring you this concise, comprehensive reference. Sections relating to history, basic science, surgical indications and techniques, complications, postoperative management, as well as a philosophical chapter on the future of spine surgery are presented. With the help of over 250 superb illustrations, Spinal Fusion: Science and Technique contains the most current and authoritative compilation of knowledge relating to surgical management of disorders of the spine. It is destined to become an essential tool in your working library.

This book has been assembled from the radiographic and photo graphic records of patients presenting to craniofacial units on four continents over 7 years. It is our purpose to illustrate a wide range of craniofacial deformities with the technique of three-dimensional com puted tomography. Many topics are briefly addressed with descriptive text intended to amplify the accompanying images but not to exclude the need for more comprehensive references as recommended in the reading list of each chapter. The ability to generate three-dimensional radiographic images rep resents a successful integration of computed tomography with com puter graphics. Although this technique remains an electronic substi tute for the study of dry skull specimens, it offers a permanent pictorial record of anatomical structures with the opportunity for fu ture interactive data manipulation. It is hoped, therefore, that this work will assist others to gain a more complete understanding of disorders of the craniofacial region. We encourage other surgeons and investigators to examine and employ the techniques used to gather these images but also to ensure that standardized scanning regimens are adapted. The importance of data collection within its full anatomical context was borne out with many of our early studies, which were limited owing to computational con straints. Often an image requirement for surgical intervention is much less than an image necessary for strict scientific inquiry."