The author John L. Fox shares his many years of teaching and surgery through more than three hundred illustrations and photographs (including over one hundred in color). Dr. Fox has published many works on neuroscience and clinical neurosurgery and is well-known for his color images of live neurosurgical anatomy as viewed through the operating microscope. Historic techniques, instrumentation and positioning, photographic techniques, cranial anatomy and the cranial flap, and intracranial anatomy as seen from the frontolateral or pterional approach are clearly discussed and illustrated from the operating (right sided) surgeons' perspective. The operations seen in this atlas for the main part involve aneurysms and some tumors. Directed toward neurosurgeons, neuroscientists, and anatomists, the book is intended to serve as an atlas of anatomy as well as a guide to clinical neurosurgery.

Intracranial injury, caused by a transorbital penetrating object, is a neglected topic in neurosurgery. With few exceptions, only occasional publications, often containing merely case histories, are present in the literature. Through a perusal of the world literature - for the first time - the author has collected and combined all available and relevant information, trying to give a thorough description of this rare, but extremely dangerous injury. This book is a major and definitive contribution to neurosurgery, but is also of importance to ophthalmology, neurology, traumatology, neuro-radiology and pediatrics.

As in any multiauthored textbook penned by When I was first approached by the publisher of this volume, Martinus Nijhoff, Boston, I writers of diverse backgrounds and interests, explored the possibility of writing a personal Modern Stereotactic Neurosurgery to some monograph on contemporary stereotactic extent suffers from incompleteness. Future surgery. After a review of available literature, volumes no doubt will include many additions several aspects became apparent. First, no cur from other authors who also are important rent, readily accessible, multiauthored text de specialists in the field. Because not all authors signed to survey the field was available. Those write in the same style (or even language), we books that were available tended to heavily have attempted to achieve a more cohesive text emphasize theory, physiology, and anatomy. in the editorial process. Each chapter has been Second, stereotactic surgeons were considered subdivided into pertinent headings for easier abstruse and for too long were relegated to a reference. Because of my own background, status outside of the mainstream of neuro some readers will note an Americanization (as surgery. This attitude probably reflected the opposed to anglicization) of the chapters. insufficient explanation of the practical uses While many chapters comprise primarily sum and advantages of stereotactic technique. maries of the authors' work within the field, Third, in recent years, the field has expanded each author was encouraged to review the liter so rapidly that it has become a major compo ature in that discipline if appropriate."

The book gives the most up-to-date information for the expanding field of stereotactic and functional neurosurgery from European and international experts. The newest developments in neural transplantation and stereotactic irradiation are included together with the reports on extensive trials of analgesic surgery and new techniques used in the treatment of a variety of functional disorders.

Since Harvey Cushing's extensive study on brain meningiomas no similar study has been conducted on spinal cord meningiomas. The high scientific value of this book is based on the careful elaboration of data from patients affected by spinal meningiomas who have been examined and operated on over the last 33 years (1962-1995) at the Neurosurgical School of the University of Florence, Italy. The main focus of this study was on the anatomic and clinical relationship that enabled early diagnosis of spinal meningiomas. More over this book emphasizes the interaction between neurology and neuroradiology in the form of "dynamic neurology." Myeloradiculographic findings are described together with those using more recent techniques such as CT and MRI.

S. Price: Advances in imaging low-grade gliomas - M. J. Riemenschneider, G. Riefenberger: Molecular neuropathology of low-grade gliomas and its clinical impact - I . R. Whittle: What is the place of conservative management for adult supratentorial low-grade glioma - D. Kurzwelly, U. Herrlinger, M. Simon: Seizures in patients with low-grade gliomas -- incidence, pathogenesis, surgical management, and pharmacotherapy - L. Bello et al: Present day's standards in microsurgery of low-grade gliomas - B. Baumert and R. Stupp: Is there a place for radiotherapy in low-grade gliomas? - F. W. Kreth et al: The place of interstitial brachytherapy and radiosurgery for low-grade gliomas - M. Klein: Health- related quality of life aspects in patients with low-grade glioma.

Professor Fox has undertaken the monumental In his Preface, Dr. Fox has quoted Cannon task of compiling the available data on intracra- and Rosenblueth in questioning where to stop nial arterial aneurysms. The magnitude and ex- the record. One can only document progress tent of the undertaking attest to the tremen- to date-and certainly the advances in this field dous amount of information which has are noteworthy-and then make some cau- accumulated in the past few decades and to tious predictions for the future. They have cor- the accelerated pace at which the field has ex- rectly made note that the overall morbidity panded, particularly since the end of World and mortality of these aneurysm patients re- War II. mains unacceptably high, largely as a result of Our heritage can be traced to many sources, the secondary complications of the subarach- among whom should be mentioned such nota- noid hemorrhage itself. More attention should bles as Willis, Quincke, Blackall, Moniz, Dott, be directed in the future to the recognition of Dandy, Hounsfield, and others. The modern era those patients with unruptured aneurysms and includes a number of investigators and clini- those with minimal bleeds. Hopefully infor- cians, some of whom have contributed to this mation will be forthcoming as to which indi- magnificent tome. The bibliography of over viduals are at risk because of some unusual con- 4000 references represents the increasing in- genital, metabolic, or acquired defect.

Normal cranial anatomy as seen by MRI in children aged 1 month to 21 years is comprehensively depicted in this atlas. As such it represents an invaluable tool for establishing normal baseline anatomy of the developing brain when evaluating suspected disease, trauma, or developmental delay in pediatric subjects. There are 124 normal cases presented, 62 each of boys and girls, at intervals from ages one month to 21 years. Six axial images are presented for each case. The images were obtained from Siemens, GE, and HI Standard machines. A brief introduction covers key issues in the development of white matter and special topics in pediatric neuroimaging.

It is, of course, a real challenge to summon together an International Sym- posium in and around the Brain Stem and Third Ventricle. Up to this mo- ment the various experiences and papers on this subject were distributed throughout the world literature, making it very difficult for someone in- terested in the matter to have access to the actual state of knowledge. Therefore I believe such a meeting was long overdue and is a considerable attempt to open closed doors for present and future ambitious neurosurgi- cal activities. After succeeding in previous symposiums of similar interest in Hanno- ver, it was obvious that Prof. Madjid Samii and his coworkers took the in- itiative of organizing such a meeting, bringing together - in the pure sense of the word - Neurosurgeons with Anatomists, Neurologists, Neuro- physiologists, Neuroradiologists, ENT-, Maxillofacial-, Stereotactic-, and Radiosurgeons as well as other colleagues. One contribution after the other followed, from the basic sciences up to the operative management con- sidering very new and actual concepts. Through the application of new microsurgical techniques and the incorporation of new understanding for the many problems afflicting the midline of the eNS, and based on a growing closer cooperation between the various disciplines, a wide field has opened up which concerns us all.

Microdialysis is a minimally invasive method which enables continuous monitoring of parameters in the extracellular space of various tissues. It has been investigated in animal models for over a decade, and many publications have provided insight into its advantages and disadvantages. However, in spite of its enormous potential for revealing metabolic processes in normal and pathological tissue, microdialysis in humans is still in its infancy. Clinical neurointensive medicine nowadays demands much more than conventional monitoring methods. As already shown by jugular bulb measurements of oxygen and lactate, in the future clinicians will want to have access to continuous neurochemical information from the patient. This information could be used to prevent those enigmatic secondary lesions which play such a negative role in neurointensive medicine, or at least enable treatment of them at an early stage. The extensive information now available from the laboratory would help with the interpretation of clinical analogues. In the University Clinic of Neurosurgery in Basel we have been involved in the field of micro dialytic monitoring for several years and have recognised the problems, both technical and ethical, which are involved in taking the difficult step from animal experiments to clinical application. In 1994 we thought that research on clinical microdialysis had reached the stage which would enable scientists and clinicians to have many fruitful discussions.

Ronald Brisman, M.D. This book will discuss three areas where the The multiplicity of procedures with varying neurosurgeon may provide an important degrees of risks and benefits sometimes re contribution to the relief of intractable pain: quires a sequential approach, but always an trigeminal and other facial neuralgias, chronic individual one, matching an appropriate treat noncancer pain, and cancer pain. By one ment plan or procedure for a particular patient intervention, the neurosurgeon often may pro at a specific time in his or her illness. vide long-lasting pain relief. New techniques, The neurosurgical chapters in this book which have developed since the 1970s and represent my experience with several hundred continue to evolve, dominate the neurosur patients during a 12-year period from 1975 gical armamentarium because they are not only through 1987. I have relied heavily on the effective, but safe. These include percutaneous works of others, which have been quoted from radio frequency electrocoagulation for trigem the neurosurgical literature, but this book is inal neuralgia, spinal stimulation for chronic not meant to be encyclopedic. noncancer pain, and intraspinal morphine in At least as important as knowing when to fusion for cancer pain. operate is knowing when not to do so, and this Sometimes a procedure relieves pain but the is particularly true of the treatment of pain. pain recurs; it may be necessary to repeat the Most patients with pain do not require neuro procedure, which in the case of radiofrequency surgical intervention."

This book is a combination of ideas and experiences from over 100 dedicated and brilliant neurosurgeons around the world. Their common goal is to provide data for a deeper understanding of the multi-faceted aspects of neurosurgery and, by doing so, to better serve patients across the globe. Scientific curiosity, deep dedication, incredible work ethics, entrepreneurship, and creativity are the common traits among all neurosurgeons, and not the exception. By allowing readers to see the field of neurosurgery from the perspectives of surgeons spanning five continents, this book serves to provide multiple, diverse viewpoints and to build a foundation for future collaborations. The book's 24 chapters are organized into 3 parts. Part I provides the reader with an overview of the role of neurosurgery in worldwide health care, its evolution over the past decades, the current state and future directions of each neurosurgical subspecialty across the five continents. Over the years, the overarching goal for neurosurgeons has been to develop new, more effective and high-end solutions for complex diseases and to provide access to neurosurgical services for all patients. Part II discusses the differences and similarities of neurosurgery education and training across the globe, providing a snapshot of how new tools, technology, and paradigms reduce inequality and increase access to neurosurgical education. Educational accomplishments and challenges still present for the in different regions of the world are reviewed. Part III focuses on economic aspects influencing neurosurgery globally, including how to make efficient decisions in the face of scarcity, yet demand. The authors provide theories, models, and tools helpful to apply when planning to allocate resources, not just financial, but also human and intellectual. A deeper understanding of economics does not necessarily provide the answer to the problem; rather it provides the tools to find an answer, or, ideally, multiple possible solutions. Neurosurgery and Global Health is the first comprehensive guide to the role of neurosurgery in the global health care sphere, providing an in-depth compendium about the understanding of the neurosurgical role within global health, its efforts in the education of tomorrow's workforce, and the economic aspects driving the field.

This full-length translation of Professor Luria's book introduces to the English speaking world a major document in neuropsychology, summarizing Professor Luria's earlier contributions to that area for nearly a third of a century. It is a monumental contribution. Nothing of this scope exists in the Western literature of this field, with the possible exception of Ajuriaguerra and Hecaen's book (in French) on the cerebral cortex. Professor Luria's book thus marks a further and decisive step toward the eventual coalescence of neurology and psychology, a goal to which only a few laboratories in the East and West have been devoted over the last decades. The book is unique in its organization. The first half deals with observations and interpretations concerning the major syndromes of man's left cerebral hemisphere: those grievous distortions of higher functions traditionally described as aphasia, agnosia, and apraxia. There is also a detailed and brilliant analysis of the syndrome of massive frontal-lobe involvement. The entire second half of the book is given over to a painstaking description of Professor Luria's tests, many of them introduced by himself, and set out in such detail that anyone could repeat them and thus verify Professor Luria's interpretations."

Many different opinions exist as to the appropriate diagnostic workup and therapy for spinal tumors. With the advent of new imaging techniques and therapeutic regimens, an up-to-date reference work has become an urgent requirement. This book is designed to meet this need, and is the first of its kind to offer an overview of the opinions of internationally renowned specialists in the field. By addressing in detail all of the relevant topics and areas of contention, it should prove of great value in establishing rational imaging and therapeutic protocols for spinal tumors.

Doctors Pellet, Cannoni and Pech have joined forces to write a masterly work on the subject of otoneurosurgery and tumors of the base of the skull. The anatomic illustrations, derived from their meticulous dissections, are of excellent quality and a credit to the famed tradition of French neuroanatomists of the past. It is evident that the operative techniques described by these surgeons indicate that they have spent a great deal of time in the dissecting-room and that they have completely mastered the temporal bone. A perfect knowledge of the fundamental anatomy of the petrous bone is essential before embarking on the difficult surgical procedures in this region of the brain and base of the skull. Reading this work makes it abundantly clear that the results of this type of sur gery are vastly improved when neurosurgeons and otologists combine their skills. Each of these specialists brings his unique experience and entire knowledge to the operation for the greater benefit of the patient. We wish to congratulate Doctors Pellet, Cannoni and Pech on the publication of this excellent work. March 1990 William F. House, MD William E. Hitselberger, MD Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Basic Anatomy .. 5 The Petrous Pyramid 7 TIle Petrous Cortex 7 Surfaces 8 14 Base ....... .

This is truly an exciting time in the field of neuro-oncology, particularly in the area of hi- grade gliomas. The management of patients with high-grade gliomas has historically been one of the most challenging and disheartening fields in medicine, where failure is the rule and longevity is the exception. The jaded often state that despite purported advances in surgical and radiotherapeutic techniques and a myriad of clinical trials of medical therapies, the s- vival statistics for glioblastoma have not changed in the last three decades. The nihilism associated with these tumors is such that some practitioners still advise against treatment or even biopsy, recommending palliative care with the diagnosis based only on history and an MRI scan. If the current state-of-the-art in the diagnosis and management of high-grade gliomas was truly so bleak, there would be no reason to compile and publish a monograph on the subject. The fact is that we have recently entered an era where real progress is being made in our understanding and treatment of high-grade gliomas that is directly benefiting some patients. We are slowly but surely chipping away at this problem. One approach has exploited correlations between particular molecular markers and therapeutic response. The first such "breakthrough" in high-grade glioma was the observation that loss of chromosomes 1p and 19q uniformly predict chemosensitivity in anaplastic oligodendrogliomas (1).

The optic canal, in particular its intracranial end, represents a "locus minoris resistentiae" for optic nerve compression in a variety of pathologic conditions. The intracranial optic nerve shares the limited space within this narrow passage with the carotid and ophthalmic artery, all being surrounded by bone and rigid dura. Any pathological condition going along with an increase of soft tissue volume, such as in optic nerve sheath tumors, parasellar neoplasms, dolichoectasia of the carotid and/ or ophthalmic artery, hematomas, etc. , or reduction of the lumen of the bony optic canal by hyperpneumatization of the sphenoid sinus, hyperostosis or developmental abnormalities must act as a space-occupying lesion causing optic nerve compression either by pressing the nerve against the vessel or the neighboring dura or bone. The spectrum of clinical signs and symptoms of optic nerve compression in this area is rather wide and includes acute as well as slowly progressive visual loss and all kinds of visual field defects in the presence of a normal disk, papilledema, pri- mary optic atrophy or cavernous optic atrophy mimicking var- ious clinical disease entities such as retrobulbar optic neuritis, anterior and posterior ischemic optic neuropathy, soft glaucoma and others. Some of the lesions causing optic nerve compression in this area are rather small and need to be visualized or excluded by thin section CT such as pneumosinus dilatans of the sphenoid bone, dolichoectasia of the internal carotid artery, small men- ingiomas around the optic foramen and others.

Neurocritical care as a subspecialty has grown rapidly over the last two decades and has reached a level of distinct maturity with the advent of newer monitoring, diagnostic and therapeutic modalities in a variety of brain and spinal cord injury paradigms. Handbook of Neurocritical Care, Second Edition remains true to the operative tenet that "time is brain," and rapid diagnosis and therapeutic interventions in these challenging patients cannot be overemphasized. The second edition of this important Handbook again serves as a quick, practical reference for those involved in the care of critically ill neurological and neurosurgical patients. The care provided to this subset of critically ill patients continues to be multidisciplinary and includes care rendered from colleagues in emergency medical services, emergency medicine, neurology, neurosurgery, anesthesiology, critical care, nursing and physician assistance. Fully updated, all of the chapters again consist of easy-to-read, bulleted points followed by a list of Key Points and important references allowing for rapid access to vital information critical for fast and timely decision making. The first section covers a myriad of important general principles while the second section addresses the major diagnostic categories of neurocritical care with several new topics; these include, for example, neuroleptic malignant syndrome and malignant hyperthermia, meningitis and encephalitis, and intraventricular hemorrhage. Readers will find the algorithms, tables, and illustrations throughout the book not only useful but truly invaluable in facilitating fast and accurate decision making. Accessible and comprehensive, Handbook of Neurocritical Care, Second Edition again fills a vital need by providing readers with a succinct and practical approach to the management of critically ill neurological and neurosurgical patients.

Don t miss it The second, completely revised and expanded edition of the successful surgical manual on minimally invasive spine surgery includes 51 chapters (including more than 20 new chapters) covering all current minimally invasive techniques in spine surgery. A complete survey of all microsurgical and endoscopic techniques with a special focus on semi-invasive injection techniques for diagnostic and therapeutic purposes in low back pain is given. The clear chapter structure with terminology, history, surgical principles, advantages/disadvantages, indications, access principles, complications, and results facilitates navigation through the manual. Topics include the principles of microsurgical and endoscopic treatment, spinal navigation and computer-assisted surgery, minimally invasive reconstruction, fusion, dynamic stabilization in fractures, degenerative disc disease, spinal stenosis, low back pain and deformities. The didactic presentation of surgical steps makes the reader familiar with all types of new minimally invasive techniques in clinical use or still in ongoing clinical trials such as minimally invasive spine arthroplasty."

Here is the first biography to appear in fifty years of Harvey Cushing, a giant of American medicine and without doubt the greatest figure in the history of brain surgery. Drawing on new collections of intimate personal and family papers, diaries and patient records, Michael Bliss captures Cushing's professional and personal life in remarkable detail. Bliss paints an engaging portrait of a man of ambition, boundless, driving energy, a fanatical work ethic, a penchant for self-promotion and ruthlessness, more than a touch of egotism and meanness, and an enormous appetite for life. Equally important, Bliss traces the rise of American surgery as seen through the eyes of one of its pioneers. The book describes how Cushing, working in the early years of the 20th century, developed remarkable new techniques that let surgeons open the skull, expose the brain, and attack tumors-all with a much higher rate of success than previously known. Indeed, Cushing made the miraculous in surgery an everyday event, as he and his team compiled an astonishing record of treating more than two thousand tumors. Moreover, Cushing was also a leading authority on the pituitary gland and a pioneer of endocrinology. And in his spare time, he won a Pulitzer Prize for his massive two-volume biography of William Osler, who was Cushing's colleague. This is the definite Cushing biography, an epic narrative of high surgical adventure. Written by a prize-winning medical historian and acclaimed author, it captures the highs and lows of an extraordinary life, illuminating the contributions of a surgeon who has earned an enduring place in the pantheon of medical history.

Emily Owen was a multi talented teenager with the world at her feet. Highly intelligent, athletic and a gifted musician, she was destined to excel in whichever field she chose to pursue. At the age of 16, Emily was diagnosed with Neurofibromatosis Type 2 (NF2) and less than a month later, she was in hospital and fighting for her life. Over the coming years, NF2 would steal her education, her smile, her hearing, her ability to walk. With her life plans in ruins, Emily struggled to find meaning and identity. Good things in her life weren't good any more. Because they were no longer there. With gentle humour and heart-breaking honesty, Emily shares her story. Slowly and painfully, she discovers value in new places, seeing the rainbows in the silence.

The pituitary gland is a very small-sized gland which plays an important role in regulating human well-being by controlling many activities of other hormone-secreting glands. It embeds in a midline, bony hollow of the cranial base and is surrounded by vital structures (eg: optic apparatus, cavernous sinuses, internal carotid arteries, and cranial nerves that control extraocular muscles). Adenoma of this gland is a challenging problem for neurosurgeons. Some are best managed with medication alone, but some are more responsive to surgery. Numerous refinements in surgical approaches to the pituitary gland have been proposed for decades. Advancements in modern surgical equipment and state-of-the-art technology of highly precise tools have given neurosurgeons a new, minimally invasive approach. Since the era of image-guided surgery, neurosurgeons have been offered many chances in innovating high precision surgical techniques via a very small incision or no incision at all. Patients received many benefits from the so-called minimally invasive surgery, particularly less side effects with greater patient comfort. Better outcome, little or no scarring, and lower complication rates of pituitary adenoma surgery resulted from little tissue manipulation by cutting-edge technology. However, the revolutionized pituitary surgery is still going ahead. Starting with the microscopic era, followed by image-guidance and then by endoscopic maneuver, all of these give neurosurgeons a streamlined, multidisciplinary approach in treatment of the pituitary adenoma. Another groundbreaking development in minimally invasive treatment for pituitary adenoma is robotic surgery. Robotic surgery of pituitary adenoma offers a wide range of treatment: passive, semiactive, active robots, and remote manipulators. Some of them are non-invasive alternatives to surgery such as Gamma Knife (R), LINAC, Cyberknife (R); they provide pain-free, non-surgical alternative treatment for surgically complex and invasive adenomas or inoperable patients. The era of robotic surgery is going to innovate pituitary glands surgery; as a technique, it is to become the gold standard treatment. Future progress will turn minimally invasive surgery into non-invasive treatment of pituitary adenoma sooner or later. This book examines all these issues and provides a prediction of what will happen in the future in the field of minimally invasive surgery, particularly for pituitary adenoma.

The perioperative neuroscience is a specialty that is continuously evolving. This specialty depends on the integration of neuroanaesthesiology, neurology, neurointensive care, neuroradiology, neurointeventional radiology and neurosurgery. This book provides in-depth information for the most recent evidence-based advances in perioperative neurosciences. It includes research on postoperative cognitive dysfunctions, the effect of anaesthetics on the growing brain, the new theories for the development of cerebral aneurysm and cerebral vasospasm, and many more. A unique feature of the book is the world-renowned authorities in anaesthesiology, neurosurgery, neurointensive care, neurology, and neuroradiology and neurointeventional radiology who helped compile it. Consequently, this book will give the reader a unique opportunity to have in-depth coverage for the most recent advances in this very important specialty.

Part of the Neurosurgery by Example series, this volume on pediatric neurosurgery presents exemplary cases in which renowned authors guide readers through the assessment and planning, decision making, surgical procedure, after care, and complication management of common and uncommon disorders. As pediatric neurosurgery approximates the anatomical and pathophysiological breadth of all specialty areas of adult neurosurgery, the cases provided are exemplary of those that are more relevant to, and seen in higher frequency, in pediatrics. The cases also demonstrate presentation and management appropriate for pediatrics, as both are distinct in pediatric compared to adult neurosurgery. Each chapter also contains 'pivot points' that illuminate changes required to manage patients in alternate or atypical situations, and pearls for accurate diagnosis, successful treatment, and effective complication management. Containing a focused review of medical evidence and expected outcomes, Pediatric Neurosurgery is appropriate for neurosurgeons who wish to learn more about a subspecialty, and those preparing for the American Board of Neurological Surgery oral examination.