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The sellar region and paranasal sinuses constitute the anatomical
sections of the skull base in which pathological entities warrant
interdisciplinary management. Processes originating in the
paranasal sinuses can reach and involve the skull base in and
around the sella, sometimes not respecting the natural dural
boundary. On the other hand, lesions involving the sellar block,
such as pituitary adenomas and meningiomas, can also extend
downwards into the paranasal sinuses. The orbit and cavernous sinus
may be subject to involvement and infiltration by both paranasal
and sellar pathology. The advancement and new achievements of
modern diagnostic procedures, such as high-resolution CT,
three-dimensional reconstruc tion, MRI, and MRI angiography, as
well as the detailed selective angiographic protocols and
endovascular techniques, have increased the possibilities for
surgical management of this type of pathology with extra- and
intracranial involvement. Long-standing and intense inter
disciplinary work has led to sophisticated operative approaches
which for benign tumors allow total excision with preservation of
structures and function, and for some malignant lesions permit an
en bloc resec tion via a combined intracranial-extracranial
approach. This volume reflects the work and scientific exchange
which took place during the IV International Congress of the Skull
Base Study Group, held in Hanover. Leading authorities in the basic
sciences including anatomy joined with diagnosticians, clinicians,
and surgeons from different fields to evaluate the state of the art
of this topic in skull base surgery."
The introduction of the operating microscope as a surgical tool
revolutionized the treatment of peripheral nerve lesions. A new era
thus began in the early 1960s, which led to a substantial
improvement in the management of nerve lesions. The results of
nerve grafting techniques have demonstrated that, independent of
the length of the defect, lesions can be successfully bridged. The
free tissue transplants with microvascular anastomosis have also
opened new, rewarding possibilities for peripheral nerve
reconstruction procedures, facilitating the achievement not only of
satisfactory anatomical but also of satisfactory fUhctional
results. In order to evaluate the state of the art and reflect
retrospectively on 25 years of microneurosurgical treatment of
peripheral nerves, numerous outstanding scientists and
clinicosurgical physicians were invited to Hanover in order to
exchange their viewpoints and experiences. An active und fruitful
discussion resulted which dealt with the many aspects of anatomy,
pathology, clinical and neuro physiology, diagnosis, and with the
surgery and physiotherapy which constitute modern-day peripheral
nerve lesion treatment. The excit ing ongoing experimental and
clinical activities have led us to support the wish and idea to
publish the scientific exchange which took place during the Hanover
symposium. I truly believe that the articles presented in this book
cover so many interesting subjects concerned with peripheral nerve
lesions that the book will serve the interested and dedicated
physician involved with such cases as a reference work for the
basics and also provide him with the therapeutic guidelines to
assist him in his daily work."
No special field of surgery dealing with the cranial nerves exists
today. This is not surprising in view of the characteristics of
this group of morphologically and topo graphically heterogenous
nerves. Morphologically we must differentiate between central
nerves (I, II and VIII) and the so-called peripheral nerves (nn.
III to VII and IX to XII), in which post-lesion rgeneration is
quite different. Anatomo-topographi cally we must consider an
intracranial and an extracranial part of each cranial nerve. For
practical reasons at operation, further subdivisions of the
intracranial course of cranial nerves are to be distinguished in
the anterior, middle and posterior cranial fossae as well as within
the petrous bone. This underscores the extensive tasks awaiting
surgeons operating in the ventral part of the brain and facial
skull as well as in the more dorsal part of the skull and neck.
This very wide field cannot be covered by a single surgical
discipline alone. In our opinion, considerable progress has been
made in surgery of the cranial nerves only in recent years. This
may be explained by the increased mastery of microsurgical
techniques by all surgeons in terested in the surgery of the base
of the skull as well as with the initiation of more
interdisciplinary consultation and jointly performed operations.
Possibilities of fu ture development can be discerned in the text.
The base of the skull separating the extra-and intracranial part of
cranial nerves should not be a barrier but a connect ing link."
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.
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."
Die Pinealisregion umfaBt den dorsalen Abschnitt des 3. Ventrikels
und des Zwischenhirns, den dorsalen Anteil des Mittelhirns und die
Vierhii- gelzisterne mit den benachbarten Liquorriiumen. In der
Diagnostik und in der chirurgischen Therapie raumfordernder
Prozesse dieser Region ist in den letzten zwanzig Jahren mit der
Erweiterung mikroanatomischer Kenntnisse, der Entwicklung moderner
neuroradiologischer Verfahren und der Einfiihrung des
Operationsmikroskops ein beachtlicher Fort- schritt erzielt worden.
Dennoch sind noch viele Probleme ungelost, vor allem weil Tumoren
der Pinealisregion selten vorkommen und weil die Funktion der
Pinealis nicht vollig gekliirt ist - zwar weiB man, daB die
Pinealis eine endokrine Driise ist, die Melatonin produziert, doch
ist die Wirkung des Melatonin beim Menschen unbekannt. Bei einem
Tumor der Pinealisregion beeinfluBt die Artdiagnose ent- scheidend
die Wahl und die Reihenfolge der therapeutischen MaJ3nah- men.
Deshalb sind nach der genauen Feststellung seiner Lokalisation und
Ausdehnung durch Angiographie, Computertomographie und
Kernspintomographie die liquorzytologische Untersuchung und die
Serum-und Liquoranalyse indiziert. Dennoch bleibt die Frage nach
dem biologischen Verhalten des Tumors oft unbeantwortet. In einem
solchen Fall kann diese Frage durch die stereotaktische Biopsie
gekliirt werden. Das vorliegende Buch liefert einen wertvollen
Beitrag zur Kenntnis der raumfordernden Prozesse der
Pinealisregion, da sowohl aufpatholo- gische und klinische als auch
auf diagnostische und therapeutische Aspekte eingegangen wird. 1m
Abschnitt iiber die Pathologie wird die Nomenklatur und die
Tumorklassifikation erliiutert, die Biologie der verschiedenen
Tumoren der Pinealisregion ausfiihrlich beschrieben und auch
aufhistochemische Befunde Bezug genommen.
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