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Spontaneous intracerebral haemorrhages are the most dangerous
complication of cerebral vascular disease. Because of their
frequency and the fact that they lead to serious injuries,
prolonged disabilities and, often, death, they have acquired an
enormous significance, both medically and socially. Their precise
diagnosis, location, wide extent and accomp ying manifestations
were for a very long time uncertain and, in small and deeply
situated haematomas, these factors were impossible to determine.
Diagnosis was confirmed by the clinical picture, by angiography and
sometimes by ventriculography and included, in the main, both lobar
and more extensive haematomas. The results of operative treatment
following the first attempt of H. Cushing in 1903 were poor and
remained unsatisfactory in spite of the endeavours of numerous
authors (Guillaume et al. 1956; Lazorthes 1956; McKissock et al.
1959; Luessenhop 1967 and many others). Especially for the most
frequent and typically hypertensive haematomas in the region of the
internal, capsule, the opinion was often expressed that operative
treatment was useless.
Tumours of the central nervous system in infancy and childhood show
so many di verse pathomorphological characteristics and present so
many diagnostic problems that a congress dealing specifically with
the subject and thus bringing together a wide range of experts in
the field seemed called for. The programme of the congress, . held
in Mainz between 22 and 24 October 1981, was designed to provide
compre hensive coverage of diagnosis and the various therapeutic
procedures, as well as of basic research in the field. The various
lectures given are contained in this book, which thus reflects the
complete spectrum of topics discussed. The interest generated by
the congress amply justified our decision to organize it.
Representatives of various specialities, such as neuropathology,
paediatrics, on cology, radiology, neurosurgery, paediatric surgery
and neurology, and, last but not least, basic research, provided
lively and interesting lectures which admittedly raised more
problems than they solved. In addition to the actual papers
presented, we attached considerable importance to the different
opinions voiced during the congress, as reflected in the
discussions included at the end of each chapter."
Microsurgery has brought about important changes and progress in
the treatment of cere bral aneurysms in recent years. Only 12 years
ago McKissock, one of the most experienced surgeons in the
treatment of aneurysms pompared the results of operative and
nonoperative treatment. He found that mortality and morbidity of
cerebral aneurysms was not significantly affected by whether the
patients have been operated upon or not. This view is held by many
neursurgeons, and was confirmed by results of the Co-operative
Study in 1969. In the review on treatment of aneurysms in Progress
in Neurological Surgery in 1969, techniques such as encasement with
plastic compounds, piloinjection, stereotactic copper or electric
thrombosis and metallic thrombosis and profound hypothermia in
anaesthesia were listed. In general, these techniques now seem to
be of little more than historical interest. Progress in recent
yeats has been so enormous that one may perhaps gain the impreSSion
that the main problems in the treatment of aneurysms have been
solved and that there are no more to be surmounted. This is
dangerous and complacent thinking, such as Lord Moynihan indulged
in during the thirties. For this reason we thought that the time
had come to assemble a group of experts who could discuss the
various unsolved and contro versial problems of aneurysm surgery in
the friendly and relaxed atmosphere of a "work shop.""
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