Echo-encephalography, introduced by LEKS ELL in 1955, has gained increasing importance for the early detection of numerous intracranial lesions in the last decade. The main advantage of this diagnostic procedure lies in the fact that it permits a rapid orientation about the spatial relationships within the skull without stressing or endangering the patient. Although this method alone only rarely allows a complete diagnosis, the echo-encephalographic findings always indicate which further diagnostic measures are most suitable for establishing the diagnosis with the greatest accuracy in every case. However, the correct interpretation of an echo-encephalogram is possible only, if the findings which are assumed to be pathological are evaluated in the light of the clinical symptomatology. Since JEPPSSON'S excellent monograph on the origin of the midline echo and its importance for the diagnosis of intracranial expansivities, published in 1961, a great deal of work has gone into the development of echo-encephalography all over the world. For this reason the possibilities of this procedure today go far beyond the mere demonstration of a supratentorial shift. Now we can frequently outline the width of the ventricles exactly and localize tumors or hematomas by means of abnormal reflections. Since a detailed description of the technique, application and present-day diagnostic uses of echo-encephalography has not been available as yet, we undertook to fill this gap in the German literature in 1967 with a monograph summarizing the hitherto existing experience as well as our own extensive case mate rial.

"Advances in Neurosurgery 22" is devoted to three main topics, the first one being Cerebellar Infarcts. Following the introduction with the microsurgical anatomy and the neuropathology of cerebellar infarction, the indication for operative treatment and its results are then discussed. The neuroradiological treatment with local and antifibrinolytic therapy for vertebrobasilar occlusion completes this section. The management and surgical approaches to the various forms of midline lesions are then presented. Special interest is centred on minimal invasive endoscopic neurosurgery (MIEN), (intraventricular tumors, optic pathway gliomas, endoscopic brainstem tumors and vascular malformations). Furthermore the special equipment and fields of indications are extensively discussed.

Advances in Neurosurgery presents the experience and research results of modern neurosurgeons confronted with urgent diagnostic and therapeutic problems. The first topic here is spontaneous intracerebral hematomas, whose localization determines the form of treatment and usually its outcome. Newer therapeutic approaches such as stereotactic removal, endoscopy and fibrinolysis supplement the results of standard operative methods. Secondly, the hydrocephalus malresorptivus is covered, presenting experience with the diagnostic value of intrathecal infusion tests, CT-cisternography, evoked potentials, and MRI CSF-flow studies, as well as aspects of neurosurgical intensive care such as barbiturate treatment, respiratory problems in head injury patients, auto-regulation mechanisms, and hospital infection. The last section is devoted to peripheral nerve surgery, reports on experience with microsurgery and various forms of anastomosis in both traumatic and tumorous nerve lesions.

Three topics of major interest for neursurgeons are covered in this volume of the Advances in Neurosurgery series, as the title suggests. First, neurosurgical standards of diagnosis and treatment are viewed from several points of view, including the legal one. Second, the many aspects of aneurysm surgery are dealt with: timing and grading, monitoring during the operation, postoperative vasospasm, Doppler sonography and new research in subarachnoid hemorrhage. Third, the diagnosis and treatment of malignant gliomas are discussed; there are preliminary reports on interstitial laser-assisted thermal therapy, immunotherapy and radiopharmaceutical substances as well as the standard forms of neurosurgical and radiation treatment.

Demands on a Neurosurgeon Under Routine Clinical Conditions' "Hardly any other field of surgery requires such meticulous asepsis. No other field requires such a protection of the tissue and such reliable hemostasis. No one will question that neurosurgery makes exceedingly high demands. However, the degree of the demands on the personal ity of the surgeon who has to carry out very serious operations to the exclusion of all others and has little opportuinity to recover psycholog ically by working on simpler cases is concealed from the outer world. The mental strain which the coworkers and staff have to tolerate may not be denied." So wrote Wilhelm Tonnis in 1939. Although fifty years have now elapsed, his appraisal is still relevant today - hence my intention to discuss the everyday demands placed on neurosurgeons. My aim is not self-glorification to engender sympathy; rather it is to highlight the effects and repercussions of such demands for the well-being of the patients entrusted to us. The major onerous demands include: - those in the operating theater - those resulting from staff problems in nursing - those resulting from legal developments - those resulting from the increasing administrative tasks that cost valuable time and energy which are lost to our actual work in look ing after patients: science and research also suffer from this. I shall not go into the latter point within this preface. Let me first turn to the strains occurring in the operating theater."

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.

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."

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."

Recent topics of interest in neurosurgery are discussed in selected papers in this volume. The first major topic deals with vascular malformations of the brain, where neuroradiological interventions and microneurosurgical treatment present major advances. The second major topic covers treatment patterns for various supratentorial tumors in Ahildhood. The interdisciplinary aspects of neurosurgical intensive care, particularly electrophysiology and anesthesia, are treated extensively.