Rapid progress in technology and its application to diagnosis and monitoring of brain tissue temperature and metabolism have resulted in advances in therapy for critically brain-injured patients and breakthroughs in understanding the pathophysiology of brain damage. The latest concept of brain hypothermia therapy clarifies targets such as brain thermal pooling, masking brain hypoxia associated with catecholamine surge, the metabolic shift from glucose to lipids, and selective radical damage of dopamine in the central nervous system. This volume explains the mechanism of brain injury and how brain hypothermia treatment differs from other hypothermia therapy in four major sections: Brain Injury Mechanism, Pathophysiology of Hypothermia, Basic Research of Hypothermia Treatment, and Clinical Studies of Brain Hypothermia. The book is a valuable source for practitioners and researchers in neurosurgery and neurology and in critical care and emergency medicine.

The first monograph dealing exclusively with the neuropsychological and psychosocial sequelae of subarachnoid hemorrhage (SAH) and its treatment. It provides an overview of basic treatment modalities and functional outcome after SAH with special emphasis on aneurysm surgery. In the methods section, neuropsychological, neuropsychiatric and capacity of daily life assessment issues in patients after SAH are reviewed, and the neuroanatomical basis of the neurobehavioral abnormalities after SAH is critically discussed. Furthermore, the frequently overseen aspects of psychological adjustment including quality of life after SAH, the hemorrhage as a psychological trauma, and rehabilitational issues are met in this book.

In the last decade, a significant paradigm shift has occurred in the way complex spinal disorders are treated. Historically, after patients failed conservative treatments-largely consisting of therapy, medications, and injections-they would be left with only highly invasive open surgical options. Now, with the development of minimally invasive surgical techniques, patients often have significantly more effective and safer treatment options available. Minimally Invasive Surgical Procedures for Pain looks at the minimally invasive approaches that can be done percutaneously and under image guidance, instead of the traditional open approaches under direct visualization. The book discusses the basic concepts of spinal surgical approaches combined with an in-depth approach to the various techniques, with the overall goals of enhancing physician knowledge and leading to improved patient outcomes and safety. Topics include decompressive procedures, spinal implants, vertebral autmentation procedures, sacroiliac joint therapies, neuromodulation procedures, and more. The topics covered in the book are important to interventionalists, as well as physicians from traditional surgical backgrounds like neurosurgery and orthopedics. A first of its kind, this text details a balanced look at the proper surgical techniques for pain, as well as best practices.

Spinal Cord Injuryor disease can happen to anyone at any time and the effectscan be devastating. Ifound this outpersonallywhen Iwas thrown from the back ofa pick up truck at age 15 was left paralyzed from the waistdown. It was during my recuperation as a young teenager that I first gained insight into the importance ofrehabilitation. 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 oftheir future, overcome their setbacks and, through collaborativesupport, 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- vided over $13 million dollars to research and rehabilitation in the areas of spinal cord injury. I hope that in some small way this funding has contributed to the development ofthe vital programmes that supported me andmanyothers. The effects ofspinal 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 ofyou to never give up on yourdreams to find the answers to the optimum treatment of spinal cord injuryand disease.

Rontgenthoraxaufnahmen richtig interpretieren

Thoraxaufnahmen, die auf der Intensivstation aufgenommen werden, unterscheiden sich in der Aufnahmetechnik und in den veranderten physiologischen und anatomischen Verhaltnissen von Standard-Thoraxaufnahmen, die am Rasterwandstativ angefertigt werden. Die Interpretation dieser Bilder bereitet selbst erfahrenen Radiologen und Intensivmedizinern haufig Schwierigkeiten.

Der Weg zur korrekten Interpretation: - Rontgen- und Aufnahmetechnik - Strahlenschutz und -belastung - Klinische Problematik und Interpretation von Thoraxaufnahmen auf der Intensivstation.

Neu in der 2. Auflage:

Bildmaterial moderner Aufnahmeverfahren

Indikationsstellung fur CT-Aufnahmen

Vergleich von Projektionsradiographie und Schnittbildradiographie und mogliche Pitfalls

Ein Praxisbuch von Radiologen, Intensivmedizinern und Medizinphysikern zum Lernen und Nachschlagen. Ein Muss fur jeden auf der Intensivstation tatigen Arzt "

On the threshold of an exciting new era for acute stroke diagnosis and treatment, the Third International Symposium on Thrombolytic Therapy in Acute Ischemic Stroke was held in Nara, Japan, in April 1994. The symposium brought together some 200 basic and clinical scientists for presentations and discussions of issues vital to the understanding of thrombolytic therapy. This volume compiles the major presentations of the symposium, with attention to applications of new diagnostic measures such as diffusion and perfusion MRI, contrast-enhanced transcranial Doppler and angioscopy. Other presentations examine the mechanisms of ischemia/reperfusion injury, hemorrhagic transformation, and reocclusion, with reviews of recent developments in thrombolytic agents. The proceedings of the symposium will be of special interest to researchers, physicians, and students in the fields of neurology, neurosurgery, and nuclear medicine, as well as those in pharmacology, critical care medicine, and related fields.

Spinal cord injury produces a unique multiplicity of problems which must be clearly understood by the considerable numbers of health care and rehabilitation professionals involved in their lifetime management. This book assumes an educational approach to spinal cord injury management, in which the individual becomes an active participant in goal setting, problem solving, and in assuming self responsibility. Rehabilitation is discussed in terms of client empowerment, client-professional partnerships and examines the client in the context of his unique socio-cultural environment.;This book attempts to present an educational and psychosocial model for the rehabilitation of people with spinal cord injuries. In line with this approach, the first chapters present a concept of empowerment in rehabilitation and of an educational view of the process of learning to live with a suddenly acquired disability. The medical aspects of spinal cord injury follow, with a study of aetiology, impairments, acute care, disability reduction and engagement in self care activities. The management of high lesions in a rehabilitation context is examined separately, since this is a highly specialised area and one which is largely ignored both in therapy literature and in professional practice. The final chapters focus upon psychological issues, and upon such issues as productivity, leisure, socialization which are important both in early phases of management and in the long term.

The approach in this book is direct and simple. The author deals only with nerve block for the "most common" pain syndromes that the average practitioner will encounter frequently. This option is highly effective, but often not used simply because oral analgesics and anti-inflammatories are more familiar methods. The clear writing style leads step-by-step to the appropriate nerve block procedure. The author also discusses succinctly practical psychological issues of pain, placebos, etc.

The 17th volume of the "Advances in Neurosurgery" contains a selection of the scientific reports of the 39th annual meeting of the German Society for Neurosurgery, which was held in Cologne from May 8-11, 1988. The first section deals in particular with the "long-term results of severe head " "injuries," as well as with problems of the acute traumatic hematomas and brain edema. The second section covers "microsurgical experiences." Attention is focused on the anatomy and operative technique for lesions in and around the "jugular foramen" and the craniospinal transition. The third section describes the special new results of "brain " "death determination." Beyond this, numerous contributions on clinical and research results were presented in a poster exhibition which was systematically studied in order to give younger neurosurgeons the opportunity for extensive discussion. The volume contains new information which will bring specialists up-to-date on the latest clinical and research developments in the field.

Perfect for anyone considering or training in this challenging specialty, Principles of Neurological Surgery, 4th Edition, by Drs. Richard G. Ellenbogen, Laligam N. Sekhar, and Neil Kitchen, provides a clear, superbly illustrated introduction to all aspects of neurosurgery-from general principles to specific techniques. Thorough updates from leading authors ensure that you'll stay abreast of the latest advances in every area of neurosurgery, including pre- and post-operative patient care, neuroradiology, pediatric neurosurgery, neurovascular surgery, trauma surgery, spine surgery, oncology, pituitary adenomas, cranial base neurosurgery, image-guided neurosurgery, treatment of pain, epilepsy surgery, and much more. Offers comprehensive coverage without being encyclopedic - just the right amount of information for those in training or who need an introduction to the field. Provides a strong visual understanding of the essentials of neurosurgery with abundant high-quality illustrations, including imaging, pathology, clinical and operative photographs, surgical line drawings, diagrams, tables, and figures. Presents information in an easy-to-understand, well-written manner, helping you quickly grasp the principles and problems of today's neurosurgery. Features new and improved videos, more emphasis on anatomy and radiology, and new evidence and techniques, keeping you up to date with the latest advances in the field. Expert ConsultT eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices.

In this book on the optimal treatment of the injured spinal cord we present the reasons why we consider it necessary to handle trauma tized medullary tissue in accordance with the classical biological principles of wound healing in general, namely by long-term, ten sion-free immobilization of the spinal cord. Today, such immobili zation for this purpose can only be achieved by surgical secure ment of slight dorsiflexion of the cervical spine. Traumatically compressed medullary tissue is invariably attenu ated and weakened. On application of skull traction, the weakened section of the compressed cervical cord is the part that is most overstretched. This inevitably results in increased neurological def icit. On scrutiny of the clinical records of 100 tetraplegic patients treated by skull traction at the National Spinal Injuries Centre at the Stoke Mandeville Hospital, Aylesbury, England, from 1971 to 1982, we found that therapeutic skull traction had been followed by an immediate increase in neurological deficit in 12% of the patients - a relatively high figure for the type of case in which beneficial effects oftraction were habitually anticipated. Moreover, in studies on cadavers, artificial defects in fresh human cervical cord in situ showed typical deformation following application of traction, confirming the basic deleterious effects of therapeutic skull traction on the injured cervical cord."

This 16th volume of Advances in Neurosurgery contains a selection of pa pers presented at the 38th Annual Meeting of the German Society of Neurosurgery, held in Munster on 3-6 May 1987. The program committee had to choose these contributions from a total of 161 presentations. I am very much obliged to the members of the committee who contributed their experience and effort to the organization of the scientific pro gram: Prof. Dr. R.A. Frowein, Prof. Dr. W.J. Bock, Prof. Dr. E. Kazner, Prof. Dr. G. Lausberg, Prof. Dr. M. Klinger, and Prof. Dr. M. Brandt. The aim of the Meeting was to exchange experiences regarding modern diagnostic and therapeutic achievements. The first main topic was new technical methods in neurosurgery. Refinements in laser technology were introduced; different laser devices have been recognized as use ful tools in microsurgery and some peripheral nerve problems. The Ca vitron ultrasonic aspirator has proven its value in a great variety of intracranial and spinal tumors within a few years. Its technical advance is impressively demonstrated by some of the papers in this book. With growing experience we have recognized the great value of these additional instruments in limited surgical fields and learned not to overestimate them in the hands of a skilled neurosurgeon."

With the exploding progress we are experiencing in the field of lasers in neurosurgery it was felt that a new volume devoted to lasers in neurosurgery is needed. As opposed to other early laser publications which were limited to North American contributors we have decided to publish Lasers in Neurosurgery which presents the findings of neurosurgeons from throughout the world. The decision to publish all contributions in English, regardless of the native language of the author, makes Lasers in Neurosurgery truly a forum for international neurosurgeons. Our intent is to make available the findings of international neurosurgeons, which are frequently published in less fa miliar languages, to neurosurgeons beyond the boundaries of the authors' countries. We hope that neurosurgeons not only in North America and Europe, but throughout the world, will profit by Lasers in Neurosurgery. November 1988 Edward F. Downing, M. D. , F. A. C. S. Contents FRANK, F. : Basic Physics and Biophysics 1 TEW JR. , J. M. , TOBLER, W. D. , ZUCCARELLO, M. : The Treatment of Arteriovenous Malformations of the Brain with the N- dymium: YAG Laser. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 CLARK, W. C. , ROBERTSON, J. H. : Laser Resection of Meningiomas 49 ASCHER, P. W. : Tumours on and in the Pons and Medulla oblongata 69 NEBLETT, C. R. : Reconstructive Vascular Neurosurgery: Micros- gical CO Laser Application. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 2 CRONE, K. R. , BERGER, T. S. , TEW JR. , J. M. : Laser Applications in Pediatric Neurosurgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

It has become increasingly difficult for the single clinician to cover the whole area of traumatology and particularly neurotraumatology. This is now a science with various specialized fields of research. The results are published in different and special journals, proceedings and books often not easily available to those responsible for the daily practical management of the patients with head injuries. Epidemiological investigations are necessary to evaluate the severity and frequency of accidents and injuries. Such studies will stress the importance of analysis of the causes and also the importance of prevention. They are useful for evaluation of the effects of injuries despite management. Moreover, the researchers of the different aspects may need some knowledge of other links in the chain of events at and after an impact. This is particularly evident with respect to the problems of accident and injury, their prevention, reduction, management and the presentation of the most important clinical features in each case for international comparisons. Therefore it is appropriate to let the different specialists briefly discuss and present their aspects of the subject. Moreover, it may facilitate and stimulate the clinicians in studying special fields of interest. This was the intention behind the "Scandinavian Symposium on Neurotraumatology" held in May 1985 in Gothenburg: - To accumulate wider knowledge for the neurosurgeon and better understanding between the researchers in various fields to the benefit of the coming and present patients. Sten Lindgren Contents Lindgren, S.: Introduction.

In 1981, the Norwegian physiologist and cyberneticist, Rune Aaslid, developed a device which made it possible to apply the transcranial Doppler sonographic technique in man. In 1983, Dr. Albrecht Harders took on the project of working out a clinically practicable method that would allow atraumatic measurements to be made of the blood flow velocity in the large branches ofthe circle of Willis. The technique has now become a competitor of the conventional methods of measuring the intracranial hemodynamics, including angiography and the xenon method of cerebral blood flow measurement. Harders proceeded from the assumption that the measurement of the blood flow velocity is more relevant for clinical diagnoses than the usual volume flow measurements. He stresses the very valuable application of the technique in detecting cerebral vasospasm before and after aneurysm surgery. The changes in the blood flow velocities measured by transcranial Doppler sonography in the individual vessel segments of the circle of Willis are interpreted with respect to the various factors that can effect such changes (collateral circulation in the circle of Willis, diameter of the vessel, vascular resistance, the general cardiovascular situation, arterial partial CO pressure, autoregulatory factors, position of body). The rate of 2 complications associated with angiography has thus been reduced, since the best time both for angiography and for surgery can be determined, and continuous TCD examinations show when the patient is out of a critical phase of cerebral vasospasm.

The first mention of moyamoya disease as a distinct disease entity was in a paper I published in 1965. The abnormal net like vessels at the base of the brain seen in cerebral angio grams of this disease were described by most native speakers of Japanese as "moyamoya," a Japanese expression for some thing hazy, such as a puff of cigarette smoke drifting in the air. In fact, prior to my advocacy of this term, this type of vascular network was often referred to as "moyamoya vessels" by Japanese researchers. In 1969, Dr. A. Takaku and I submitted a paper to the Ar chives of Neurology entitled "A Disease Showing Abnormal Net-like Vessels at the base of the Brain," with a subtitle of "Moyamoya Disease." The editor, however, interchanged the main title and the subtitle and brought this term "moyamoya" to fame! Since then, researchers throughout the world have been using this poetic word! For a nicknaming godfather like me, it is a special joy to have this Japanese word enter the honored ranks ofmedica1 terminology. My first publication concerning this lesion was a report discussing six cases in 1963. Therefore it is now 20 years since I first became aware of and started to study moyamoya dis ease. At first, I merely thought that it was a strange vascular network, unique to these first few patients, and I reported these cases as being cases of acquired collateral vessels.

This supplement to "Acta Neurochirurgica" contains a selection of papers which were presented at the 9th Scientific Meeting of the European Society for Paediatric Neurosurgery on Space Occupying Lesions of the Cerebral Midline in Vienna, October 10-13,1984. This meeting was arranged at the same location where the ESPN was founded exactly seventeen years ago. Although the presentations in this meeting dealt with numerous important problems encountered in paediatric neurosurgery, the main emphasis was on that special problem which exemplifies the extraordinary advances in paediatric neurosurgery and its related fields. Therefore the main topic of this scientific meeting was dedicated to the subject of "Space Occupying Lesions of the Cerebral Midline." Recent diagnostic procedures, such as computerized axial tomography and magnetic resonance imaging, now enable the neurosurgeon preoperatively, to obtain precise data on the location, and in many cases also on the nature of a lesion deep within the brain. Fundamental new knowledge in neuroanatomy and neurotopography has now transformed previous high-risk procedures into routine ones for the neurosurgeon, and an abundance of new surgical techniques has improved the success rate in the treatment of many patients. The scientific meetings of the ESPN have proved to be a successful forum for the exchange of experiences, opinions and even critical discussions. The present selection of papers will undoubtedly support this endeavour. Wolfgang T. Koos Gerhard Pendl Contents A. Statistics Koos, Wo To, Horaczek, Ao: Statistics of Intracranial Midline Tumors in Children 0 1 B.

This series of yearly books on Advances in Neurotraumatology is being published under the auspices of the Scientific Committee of Neuro traumatology of the World Federation of Neurological Surgeons. For some years neurotraumatology was perhaps too much looked upon as a secondary part of neurosurgery. But the constant increase of cases has provoked a renewal of interest all over the world, involving not only neurosurgeons but also any surgeon who has to take care of such patients. Each volume, in order to cover the whole of neurosurgery, will be concerned with a special topic, the various chapters of which being envisaged in detail, and followed by a practical "How to do it." Every volume will also contain chapters outside the envisaged topic regarding some up-to-date problems. The authors, chosen from various countries for their special competence, will try to offer an efficient contribution to the knowledge of neuro traumatology, and also to present a bedside series of handy books helping those who tend these cases. The first volume will deal with "Extracerebral Collections," the second "Dorsal and Lumbar Spine and Spinal Cord Injuries," the third "Cerebral Contusions, Lacerations and Hematomas," and the next ones will continue to successively approach all the other neurotraumatological topics."

This 13th volume of Advances in Neurosurgery presents thos.e papers held at the 35th Annual Meeting of the German Society of Neurosurgery in Hannover, June 13-16, 1984. Of 150 papers submitted, the program com mittee of the Society chose 69 for presentation. I would like to thank Professors Bock, Brock, Jensen, Wenker, and Wlillenweber for their as sistance in the selection. It was the intention of the President of the Congress at this meeting to lay special scientific emphasis on discussion. For this reason the number of papers had to be limited even more than usual in order to give all participants the opportunity for questions and the presenta tion of their own experience. The main topic of the first day was Extra-Intracranial Anastomoses. Here the operative experience and the long-term results of these operations in the German-speaking countries were reviewed. This discussion was preceded a day earlier by a satellite symposium on the possibilities of the prophylaxis and treatment of ischemic neurological deficits fol lowing subarachnoid hemorrhage by means of calcium antagonists. Microsurgery at the Edge of the Tentorium was the second main topic. In co operation with the SOCiety's microneurosurgery working group, only a small number of lectures were planned, but the topic was covered thor oughly in a round-table discussion."

This volume is the latest in the series Exercises in Radio logical Diagnosis, launched by the Strasbourg School of Radio logy. Further volumes on the facial bones, senology, and abdominal tomography are in preparation. Jean-Louis Dietemann has over a decade's experience of radiodiagnosis of the skull, and has already proven his talents as a teacher with his earlier books on the sella turcica and on carotid angiography. The present volume will assuredly be a great success and will enhance the series. Professor A. W ACKENHEIM Hospices Civils de Strasbourg Centre Hospitalier Regional Service de Radiologie I Strasbourg v Contents Part One: Iconography . . . . . . . . . . . . .. . . 1 . Part Two: Commentary with Corresponding Schemata. 85 References . . 165 Subject Index 167 VII Part One Iconography 1 1 a b 3 2 a b 4 3 4 5 6 6 a b 7 7 8 8 a b 9 9 10 10 11 a b 11 12 13 a b 13 a b 14 b 15 16 17 16 17 20 18 21 a b 19 22 a b 20 21 24 a b 22 b 23 26 27 24 a 25 26 29 27 31 32 28 33 34 29 35 36 30 37 a b 31 38 39 32 40 41 33 42 43 34 44 a b 35 44 c 45 a 36 45 b ~----~------~~ c 37 46 47 38 48 49 39 50 a b 40 41 52 53 a 42 53 b 54 a 43 54 b 55 44 56

This book contains the contributions to the symposium "Functional Mapping of the Brain in Vascular Disorders", held at the Thirteenth World Congress of Neurology, Sep- tember 1-6, 1985 in Hamburg, FRG. I have to thank the contributors to this symposium for submitting their manu- scripts long before the congress so that the printed procee- dings could be distributed to the audience. I hope that this will enable the participants in this symposium not only to recall the vivid presentation of the lectures and the highlights of the discussions, but also to widen their knowlegde of the topics dealt with during the symposium by rereading the chapters on the various issues. I would also like to express my thanks to the company UCB, Kerpen, FRG, who sup- ported the symposium and the printing of these proceedings. W. -D. HEISS Cologne, July 1985 Contents The Purpose of Functional Mapping in Focal Cerebral Ischemia W. -D. Heiss ...1 Positron Emission Tomography Versus Nuclear Magnetic Resonance Imaging? M. M. Ter-Pogossian (With 1 Figure) ...5 Aims on Phosphorus-3l Magnetic Resonance Imaging K. Kogure, H. Ohtomo, S. Matsui, and H. Kohno (With 10 Figures) ...1 5 In Vivo Nuclear Magnetic Resonance Imaging of Sodium-23 in the Human Head S. K. Hilal, A. A. Maudsley, J. B. Ra, H. E. Simon, P. Roschmann, S. Wittekoek, Z. H. Cho, and S. K. Mun (With 5 Figures) ...29 Uncoupling of Flow and Metabolism in Infarcted Tissue T. Jones, R. J. S. Wise, R. S. J. Frackowiak, J. M.

Almost a hundred years passed from the time of the first description of an intracranial aneurysm by Morgagni in 1761 to the year 1859, when Sir William Withey Gull arrived at the conclusion that haemorrhage in the subarachnoid space is caused by ruptured aneurysms. The introduction of lumbar puncture by Quincke 1891 and cerebral angiography by Moniz 1927 made it possible to establish the diagnosis of haemorrhage and its source. In recent decades the problems of treatment have come into prominence, first of all because of the inadequacy of conservative methods of treatment in most of the cases, and from surgical experience and its limitations which became apparent before very long. Because of the erratic development of neurosurgery and vascular surgery, above all, since the technique of microsurgery has been used, the entire removal of the source of haemorrhage has become a possibility, even though there were still quite different views taken regarding the most convenient time for surgical intervention, apart from the prevailing local conditions 134, 143, 144,261. In an up-to-date plan of treatment of subarachnoid haem orrhage (SAH) conservative measures are appropriate for bridging the pre-operative period, and must be considered the only solution in those cases in which the source of haemorrhage cannot be found. As far as the effectiveness of such conservative therapy is con cerned, the rate of re bleeding and the mortality provide sufficient comment.

Local interstitial radiation therapy of intrinsic and inaccessible brain tumors is confronted with two major problems: 1. The tolerance of normal brain tissue, which is usually involved in local tumor irradiation, i.e. perifocal white matter edema and demyelinating effects, is crucial. 2. Data on radiation effects of implanted radioactive sources on neoplastic tissue, i.e. data on the radiosensitivity and on the biology of tumors, are still widely unavailable. In clinical practice the dose with which to achieve a given volume of tumor necrosis is roughly estimated. This report deals with the experimental findings of Iodine-125 and Iridium-I92 permanent implants in healthy and neoplastic brain tissue. Our own experimental findings are correlated with experimental data on Yttnul11-l)O irradiation from the literature. The study is directed to collect data on the tolerance non-tumoral brain tissue and to attempt to establish a dose-response relationship. Morphologic Changes in the Dog Brain Following Interstitial Iodine-125 Irradiation Iodine-I25 seeds (manufactured by 3 M Company, St. Paul, M. N.) with an activity of 3.55 mCi were permanently implanted under stereotactic conditions into the subcortical white matter of the gyrus coronalis of the left hemisphere in 6 beagle dogs. One animal with a non-radioactive seed implanted under similar operative conditions served as a control. The animals were allowed to survive 25, 46, 71, 94, 248, 368 days, respectively, after the implantation. The control animal survived 46 days. A detailed description of the experimental procedure is given elsewhere 16. 17.

The computer tomograms of the brain were investigated in 195 patients in whom a primary carcinoma was known to be present. Metastases of bronchial and mammary carcinomas are most frequent. It is not possible to achieve a definite differentiation of brain metastases from known primary tumors. References 1. Kazner, E. , Wende, S. , Grumme, Th. , Lanksch, W. , Stochdorph, 0. : Computertomographie intrakranieller Tumoren. Berlin, Heidelberg, New York: Springer 1981 2. Nadjmi, M. , Piepgras, U. , Vogelsang, H. : Kranielle Computertomo- graphie. Stuttgart: Thieme 1981 3. Penzholz, H. : Die metastatischen Erkrankungen des Zentralnerven- systems bei besartigen Tumoren. Acta neurochir. Suppl. ~, 1968 4. ZUlch~ K. J. : Pathologische Anatomie der raumbeengenden intra- kraniellen Prozesse. In: Handbuch der Neurochirurgie, Bd. III, Hrsg. Krenkel, W. , Olivecrona, H. , Tennis, W. Berlin: Springer 1956 18 Epileptic Seizures in Brain Metastases B. Neundorfer Klinik fUr Neurologie, Medizinische Hochschule LUbeck, Ratzeburger Allee 160, D-2400 LUbeck 1 Epileptic seizures are a frequent symptem ef intracranial space- eccupying lesiens (4). The reperted frequency in the literature var- ies between 13% and-abeut 50%. This apparent discrepancy can be ex- plained by the different cempesitien ef different series with regard to. the patient's age, turner histelegy and lecatien (4). The mest frequently enceuntered finding in patients with symptematic seizures is a primary brain turner: at the tep ef the list eligedendregliemas, astrecytemas and meningiemas - at the bettem glieblastemas. Brain metastases are also.