Of all the therapies that comprise psychiatric practice, the use of brain surgery to modify behaviour is the most contentious. That such behavioural neuro surgery, or psychosurgery, provokes opposition is far from surprising. The paramount status of the brain seems to belie mechanical intervention. The irreversible nature of the intervention seems to aggravate the outrage. Thus, opponents of the practice contend that psychosurgical procedures constitute a grievous assault on the integrity of the personality. Its proponents, on the other hand, confidently testify that it is a valid and efficacious form of treat ment for many seemingly intractable psychiatric disorders. Argument and counterargument have pursued the practice since its initial upsurge in the 1940s, although the decline in its popularity in the 1960s occasioned a tem porary cease-fire. However, the recent resurgence of psychosurgery has ensured that it is once again a matter of controversy. In the United Kingdom the characteristically subdued tenor of the debate frequently obscures the popularity of the practice and the commitment of its opposition. A recent application by the Royal College of Psychiatrists to the Medical Research Council for funds to mount a large controlled trial of psychosurgical procedures was turned down. Several opposition lobbyists might claim some credit for the proposal's lack of success. The Schizophrenia Association of Great Bri tain clearly and publicly expressed their disapproval of the trial. The Patient's Protection Law Committee presented Parliament with a petition condemning the Royal College's submission."

Because of the topographic and pathophysiologic information obtained with contemporary neuroimaging techniques, CT and MR scanning now constitute the most important investigation in clinical neurology. In many instances of mass lesions, the images provide a reliable or near-definitive diagnosis, and make possible the accurate and even selective acquisition of biopsy samples. For pathologists and neuropathologists rendering a brain biopsy service, a basic knowledge of CT and MR scanning is now mandatory, and the objective of this atlas is to present the principles of neuroimaging through clinicopathological correlation. It contains a wide range of clinical material, with over 600 CT and MR images correlated with over 400 full-colour pathomorphological micrographs. A full discussion of differential diagnosis is complemented by extensive references. Although aimed mainly at pathologists in neurosurgical practice, the atlas will also benefit neurosurgeons and radiologists, especially those in training.

At the 8th European Congress of Neurosurgery, which took place in Barcelona, September 6-11, 1987, a great number of papers from all fields of neurosurgery were presented, reflecting the major advances that have been achieved in recent years. The Programme Committee of the European Association of Neurosurgical Societies has selected the highlights of the congress for publication. These contributions were carefully edited and compiled in two supplement volumes of Acta Neurochirurgica.

For the beginner or for the accomplished sinus surgeon, mastering the anatomy of the lateral nasal wall is an ongoing challenge. Even though there are excellent standard anatomical references and equally outstanding sinus courses with cadaver dissection, a reference depicting the surgical anatomy is needed. A step-by-step surgical approach on the anterior nasal spine to the anterior wall of the sphenoid is presented. The sinus surgeon is confronted with a wide range of different spaces created by the ethmoid bone. No other bone in the human body has so many anatomical variations. Four critical anatomical structures are emphasized as the foundation for a precise approach to surgery of the maxillary, anterior ethmoid, frontal, and posterior ethmoid sinuses. The goal of this book is to meet the tremendous challenge of offering an anatomical approach which will serve the sinus surgeon of every level of experience and expertise.

As a result of its structure, the skull base forms a borderline between different medi cal and surgical specialties. Nevertheless, the pathology of the skull may involve crossing these boundaries. Consequently, treatment may require a multidisciplinary approach with close cooperation between different specialists, each with his specific knowledge and capabilities. A good example is the cooperation needed in the treat ment of skull base trauma. The Skull Base Study Group was founded some years ago in view of this situa tion. Its purpose is to organize international conferences on topics related to skull base pathology. The first was held in June 1982 and focused on the area of trauma tology. The present volume contains articles written by the highly qualified con tributors to the June 1982 conference, dealing with the anatomical, biomechan ical, and neuroradiological aspects of skull base fractures and their consequences in neurologic and vascular dysfunction and deficits. Many authors from Europe and abroad have contributed to the high standard of this book. I would like to congratulate the Editors on the publication of this volume. It contains many important and interesting aspects of particular value to all medical and surgical specialists working in or on one of either sides of the skull base."

th The 8 European Congress of Neurosurgery which took place in Barcelona from September 6 to 11, 1987, was an unforgettable experience. Many factors contributed to its success: the splendid ambience of Barcelona, the generous hospitality and warm friendship of the hosts, and the marvellous organization and high scientific standard of papers, workshops and discussions. For financial reasons it would not have been possible to publish all the papers presented during the congress. In order to preserve as much as possible of the scientific results, the Programme Committee of the European Association of Neurosurgical Societies had already selected before the congress a certain number of abstracts to be published as full papers. These are compiled in two supplement volumes of Acta Neurochirurgica and deal with the following main topics: Volume 1: 1. Intraoperative and posttraumatic monitoring and brain protection 2. Cerebro-vascular lesions 3. Intracranial tumours 4. Benign intracranial cystic lesions, hydrocephalus, CSF-volumes 5. Central pain syndromes Volume 2: 6. Spinal cord and spine pathologies 7. Basic research in neurosurgery. The Editors F. Isamat, A. Jefferson, F. Loew, L. Symon Contents Listed in Current Contents VI. Spinal Cord and Spine Pathologies Fornari, M., Pluchino, F., Solero, C. L., Giombini, S., Luccarelli, G., Oliveri, G., Lasio, G.: Microsurgical Treatment of Intramedullary Spinal Cord Tumours ...3 Yasui, T., Hakuba, A., Katsuyama, 1., Nishimura, S.: Microsurgical Removal of Intramedullary Spinal Cord Tumours: Report of 22 Cases ...9 . .

Both a theoretic text book and a descriptive atlas, this standard reference in the field presents the individual steps of each surgical procedure. It represents the current perspective in the management of the childs nervous system and discusses at great length the individual pathological entities which may be treated surgically. Numerous illustrations highlight both the operative technique and theoretic principles sections of the book, whereas the neuroimages are used in the theoretic principle section - accentuating the correlation of imaging with surgical planning and decision making. Recent world literature has been systematically reviewed, analysing critically different perspectives.

This monograph highlights modern concepts of brain ischemia and strategies of neuroprotective therapy. The first part of the book is devoted to mechanisms of ischemic brain damage. The authors present the results of their own clinical and experimental studies conducted in the last two decades, as well as the achievements of native and foreign neurological researches that open a new stage in understanding how reversible changes of blood flow and metabolism are transformed into a permanent morphological lesion, i.e. brain infarction. The most important advances in areas of ischemic energy failure, main mechanisms of the glutamate-calcium cascade, influence of metabolic acidosis on ischemic damage, delayed neuronal death connected with microglial activation, local inflammation, autoimmune reactions, trophic dysfunction, and apoptosis, as well as of reaction of the stress-mediating endocrine system to focal brain ischemia are shown in animals and humans, and the relevant literature is cited and critiqued.The book also explores topics that recently have experienced substantial growth, such as gene expression and subsequent molecular events in response to acute brain ischemia, connected with both tissue damage and reparation. The authors demonstrate not only universal features of the process of brain ischemia, but also individual peculiarities of its course in patients and analyse their reasons.

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.

Developments in the field of instrumentation of innovative instrumentation. Although laser applications have permeated nearly every aspect are among the major contributions to human advancement. The history of surgery has seen of surgical therapy, the expectations have fre many revolutionary developments cause quantum quently been unrealistic and the evaluation of leaps in progress. Electrocautery, the anesthesia technological development has always been machine, computed axial tomography, and the painfully slow. The properties of vaporization, surgical microscope are all revolutionary in coagulation, and cutting unified in an invisible struments that have irrevocably changed the shaft of light have enabled the neurosurgeon to direction of neurological surgery. vaporize inaccessible tumors of brain and spinal In the early stages of application, there are cord, harness recalcitrant bleeding sites, and cut always detractors and valid controversy concern through the most formidable calcified tumors. ing the value of a new instrument. Some will The application of this new energy form in remember those who argued that the magnifica tandem with the surgical microscope has, in my tion and illumination provided by the micro opinion, extended the scope of all aspects of scope were not valuable to the skilled surgeon neurosurgery. We have much more work to do. and would prolong the operative time and in lt is necessary to document improved results and crease infection rates. Others may recall that demand technological advances and safe inno Cushing was told to abandon the blood pressure vations."

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."

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.

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.

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 idea for the present volume grew from discussions that the four of us had among ourselves and with our colleagues at recent scientific meetings. All of us were impressed by the wealth of empirical data that was being generated by investigators interested in brain damage and recovery from both behavioral and biological orientations. Nevertheless, we were concerned about the relative paucity of attempts to evaluate the data provided by new technologies in more than a narrow context or to present new theories or reexamine time-honored ideas in the light of new findings. We recognized that science is guided by new technologies, by hard data, and by theories and ideas. Yet we were forced to conclude that, although investi gators were often anxious to publicize new methods and empirical fmdings, the same could not be said about broad hypotheses, underlying concepts, or in ferences and speculations that extended beyond the empirical data. Not only were many scientists not formally discussing the broad implications of their data, but, when stimulating ideas were presented, they were more likely to be heard in the halls or over a meal than in organized sessions at scientific meetings."

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.

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.

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 book is written for the clinician, students, and practitioners of neuropsychology, neuropsychiatry, and behavioral neurology. It has been my intent throughout to present a synthesis of ideas and research findings. I have reviewed thousands of articles and research reports and have drawn extensively from diverse sources in philosophy, psychol ogy, neurology, neurosurgery, neuropsychiatry, physiology, and neuroanatomy in order to produce this text. Of course I have also drawn from my own experience as a clinician and research scientist in preparing this work and in this regard some of my own biases and interests are represented. I have long sought to understand the human mind and the phenomena we experience as conscious awareness. After many years of studying a variety of Western and Eastern psychologists and philosophers, including the Buddhist, Taoist, and Hindu philosophical systems, I began, while still an undergraduate student, to formulate my own theory of the mind. I felt, though, that what I had come upon were only pieces of half the puzzle. What I knew of the brain was minimal. Indeed, it came as quite a surprise when one day I came across the journal Brain as I was browsing through the periodicals section of the library. I was awed. An entire journal devoted to the brain was quite a revelation. Nevertheless, although intrigued by the possibilities, I resisted."

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).

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 ....... .

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.

The one-stop guide to microsurgical and endoscopic treatment of skull base lesions from global experts A deep knowledge of regional anatomy, improved understanding of pathologies and their behaviors, technological advances, and multidisciplinary collaboration have led to more effective treatments for once inoperable skull base lesions. Microsurgical and Endoscopic Approaches to the Skull Base: Anatomy, Tactics, and Techniques by renowned skull base neurosurgeons Luis A. B. Borba and Jean G. de Oliveira presents a balanced, anatomy-based perspective on microsurgical and endoscopic approaches to manage these highly challenging lesions. The text leverages the best current scientific literature on this topic and insights from global skull base surgery experts. Organized into 9 sections and 52 chapters, the book starts with discussion of microsurgical and endoscopic instrumentation and neurophysiological monitoring. The subsequent sections cover diverse approaches for skull base lesions involving the sphenoid and parasellar, orbit, anterior fossa, cavernous sinus, temporal bone and jugular foramen, and foramen magnum regions. Each of these sections starts with an introduction, followed by a microsurgical description of the anatomy of the impacted region. Key Highlights Contributions from an impressive group of internationally renowned neurosurgeons and otolaryngologists specializing in skull base pathologies Indications, preoperative and postoperative concerns, nuances, pitfalls, tactics, techniques, and references for further reading provide a comprehensive guide to treatment A stepwise description of the approach, high-quality four-color drawings, and illustrative cases facilitate acquisition and retention of knowledge High-quality figures provide greater visual insights and step-by-step guidance on how to perform specific procedures This unique textbook will help residents, fellows, and practitioners in neurosurgery and otolaryngology make an evidenced-based decision on using the most effective microsurgical and/or endoscopic approach to achieve the best outcomes in patients with skull base lesions. This book includes complimentary access to a digital copy on https://medone.thieme.com.