M. Brock - Böcker

This volume contains the papers presented at the 24th Annual Meeting of the Deutsche Gesellschaft fur Neurochirurgie, held in Mainz, Western Germany, on April 30 - May 3, 1973. Deliberate choice was made of two crucial still hotly debated subjects which, for ages, have meant a source of constant worry, and nights without sleep to every neurosurgeon. Just as long as our special field exists, there have been the problems of how to control brain edema and ·of how to reduce lethality and the secondary lesions in surgery of cerebello-pontine angle tumors. Concerning the first subject, new pathological, pathophysiological and chemical aspects, the mechanisms of brain edema formation and resolution are presented in the hope for better understanding. Furthermore, the relationship between brain edema, intracranial pressure, cerebral blood flow and metabolism are discussed. Finally, the therapeutical consequences as well as the results of experimental and clinical work are presented, and a comparison of effects between different methods (hypertonic solutions, diuretics, steroids, controlled hyperventilation, hyperbaric oxygen) is given. Concerning the second main subject, any important contributions to the early diagnosis of cerebello-pontine angle tumors have been included. Nevertheless, it is of utmost interest for the neurosurgeon to know which approach he is to prefer for the different stages of tumor size and to be familiar with the trans­ labyrinthine approach or the posterior craniotomy, as well as with the importance of the use of the microscope in neurosurgery, the preservation of the facial nerve and, in certain cases, its repair.

On this occasion we look back on 25 years of the Deutsche Gesellschaft fur Neuro­ chirurgie. They hold a great deal: founding and development of the society, comple­ tion and extension, communication between the individual members and contacts to other societies beyond our borders. They also stand for close co-operation with those who transfer their patients to u- the neurologists and specialists in internal medicine, the ophthalmologists and ear­ nose-and throat specialists as well as the general surgeons. This 25th annual meeting will deal with two examples of diseases that present common problems to the neurologist and to the neurosurgeon, namely meningiomas and multiple sclerosis. In view of their long histories often going back over many years, both of these lesions lead to diagnostic errors and indequate treatment. And yet it should be possible to recognize meningiomas at an early date and to initiate the only possible treatment, the operation,if all diagnostic measures are repeatedly carried out. The diagnosis MS, on the other hand, with the multiplicity of symptoms which are peculiar to this disease, should continue to be re-examined until every other lesion has been excluded with certainty. The increasing number of legal proceedings because of diagnostic and therapeutic measures as well as the doctor-patient talk preceding the written consent for these measures are further problems in need of discussion. For this reason, the topic "medical liability in special reference to the neurosurgeon" was chosen for this meeting. Many questions necessitate many answers.

This volume contains the papers presented at the 26th Annual Meeting of the Deutsche Gesellschaft fUr Neurochirurgie, held in Heidelberg, Western Germany, on May 1-3,1975. Since at recent meetings of the German Neurosurgical Society central pathophysiological problems such as "central dysregulation" and "brain edema" had been discussed extensively, it seemed appropriate to choose another major area of cerebral patho- physiology for the meeting in Heidelberg. CEREBRAL HYPOXIA is, as LANGFITT once emphasized, "the final common denominator" of various cerebral lesions with which the neurosurgeon is confronted every day. Raised intracranial pressure, respiratory disorders and disturbances in systemic arterial blood pressure, etc. may lead, if not treated, to a focal or global lack of oxygen in the brain tissue. Anoxia finally results in cell death and thus in irreversible cerebral damage or even death. Main interest has therefore been focussed on disturbances in cerebral perfusion pressure ("ischemic hypoxia") and in arterial oxygenation ("hypoxic hypoxia").The importance of cerebral autoregulatory mechanisms protecting the brain against tissue hypoxia, of patho- morphological alterations of the cerebral vessels (e. g. the "no-reflow-phenomenon") in the course of severe hypoxia, and of changes in brain metabolism have been discussed on a large scale. The organizing committee was particularly happy to have obtained internationally well-known scientists who presented their work in the field of cerebral hypoxia.

The Neurosurgeons of Berlin are happy to welcome their colleagues from Germany and from foreign countries to our Annual Meeting, being held in this city once again after many years. The external appearance of the city may have changed in many respects since our winter meeting in 1965. This ist not the case, however, as concerns the outstanding quality of its cultural life. We hope that you take as much profit of it as possible. When choosing the scientific themes of this congress, we were led by the idea that problems should be discussed which are not dealt with at special symposia this year. Thus, the problems related to lumbar disc surgery and its complications were chosen as one main topic. This important chapter of neurosurgery worries (and not seldom depresses) us in our daily work.A joint statistic analysis has been made, for which we are indebted to the colleagues from the following university clinics: Essen, Freiburg, Graz, Hannover, Heidelberg, Kiel, Koln, Mainz, Wiirzburg, Berlin-Charlottenburg, Berlin- Steglitz, of the Neurosurgical Department of the BG-U nfallklinik Frankfurt/Main, of the Neurosurgical Department Wagner-J auregg-Krankenhaus Linz, of the Neurosurgical Clinic of the Katharinen-Hospital Stuttgart, and of the Neurosurgical Clinic of the Stadt. Krankenhaus Berlin-N eukolln.

Die Erfahrungen vergangener Jahre haben uns veranlaßt, die Thematik und den Referentenkreis der Fortbildungsveranstaltungen des Berufsverbandes Westfälischer Nervenärzte in den Jahren 1975 und 1976 so zu wählen, daß durch die Veröffentli­ chung der gehaltenen Vorträge ein Nachschlagewerk von unmittelbarer praktischer Bedeutung für jeden in der Neuropsychiatrie und ihren Nachbargebieten Tätigen zustande kommen würde. Dies ist gelungen, weil alle Autoren in ihren Übersichtsrefe­ raten zwar den neuesten Stand der Wissenschaft berücksichtigt, dennoch den praktischen Gesichtspunkten den Vorrang eingeräumt haben. Durch Anwendung zahlreicher Illustrationen sollen dem Leser wichtige Punkte optisch einprägsam übermittelt werden. Dieser Band befaßt sich mit 4 Hauptthemen. Mit der Problematik der intrakraniellen Drucksteigerung und des Hirnödems sieht sich jeder von uns fast täglich konfrontiert. Es kommt nicht nur darauf an, die modernen Methoden der Überwachung des Schädelinnendrucks zu kennen, vielmehr geht es um die klinische Erfassung und die Behandlung des Hirnödems und seiner schwerwiegen­ den Folgen. Ebenso aktuell ist die im 2. Abschnitt dieses Werkes behandelte Frage der Pathophysiologie und Therapie des Schmerzes. Hier wurde auf die Darstellung der neurophysiologischen Grundlagen besonderer Wert gelegt. Ein Nachschlagewerk für die alltägliche Praxis wäre ohne die Einbeziehung von EEG, Echoencephalographie und EMG unvollständig. Diese Methoden sind in den meisten Praxen vorhanden. Dem Leser dieses Werkes wird die Möglichkeit geboten, sich mit aktuellen Problemen auf diesem Gebiet auseinander zu setzen.

Fifty-two patients operated on for this type of spondylogenic myelo- pathy by the anterior approach were reexamined. The male: female re- lation was 2 : 1. Fifty percent were males in the 5th decade. About 20% had a congenital narrow spinal canal with an ap-diameter below the minimal standard values (3). The maximum of spondylogenic narrow- ing was found between C4 and C6 in 2/3 of the cases. Results: good 44%, satisfactory 31%, unchanged 13%, deteriorated 12%, mortality O. The duration of the neurological symptoms before operation had no in- fluence on the surgical results. Final neurological restitution was reached within 1 week to 3 months after the operation. The operative results in patients with congenital narrow spinal canal showed the same percentual distribution as the results of the entire group. No factors could be found to explain the groups of unsatisfactory results. References 1. DECKING, D. , STEEGE, W. ter: Rontgenologische ParametAr der Hals- wirbelsaule im seitlichen Strahlengang. Die Wirbelsaule in Forschung und Praxis, ~ (1975) 2. HERRMANN, H. D. : Neurologie in Praxis und Klinik. HOPF, H. C. , POECK, K. , SCHLIACK, N. (Hrsg. ). Stuttgart: Thieme (in press) 3.PIEPGRAS, U. : Neuroradiologie. S. 88-89. Stuttgart: Thieme 1977 114 Classification and Prognosis of Cervical Myelopathy E. HAMEL, R. A FROWEIN, and A KARIMI-NEJAD Introduction Up to the present, 104 patients with cervical myelopathy caused by cervical disk lesions, have been operated on in our clinic.

This 14th volume of Advanaes in Neurosurgery includes the papers presented at the 36th Annual Meeting of the German Society of Neurosurgery in Berlin, May 12-15, 1985. I would like to take this opportunity to thank the members of the program committee of the Society, Priv.-Doz. Dr. Klinger, Professors Brock, Dietz, Frowein, Lausberg, Wlillenweber, and Dr. Reuter for their assistance in selecting the contributions and in organizing the scientific program. The first main topic of the meeting was Spinal Cord Tumors. Introductory lectures dealing with basic anatomic knowledge, neuropathological as- pects, and neurologic problems were followed by reports on examinations using conventional neuroradiology, scintiscanning, computer tomography as well as the most recent method in the diagnosis of spinal tumors, the magnetic resonance tomography. Also presented were the results of a multicentered study on spinal tumors, ascertained in cooperation with 43 German and Austrian neurosurgical clinics. The participants reported in great detail on the statistical data they recorded from 3056 cases and on the scientific findings obtained from this study.The session concluded with lectures on the possibilities for surgical treatment of spinal tumors and on oncologic and radiotherapeutic mea- sures. E:x:perimental Neurosurgery was the second main topic. Leading authorities in the field presented interesting papers on topics such as the therapy of vasculogenetic brain edema, the determination of neurotransmitters in brain tumors, results of cerebral blood flow measurement, and im- proved operative techniques using laser radiation.

Since the early days of neurosurgery the management of patients with intracranial hypertension has formed part of the day-to-day routine of the neurosurgeon. The introduction of modem techniques for the clinical monitoring of the intracranial pressure (ICP) meant a firmer basis for the diagnosis and treatment of these patients but it also started a new research boom in the pathophysiology of ICP, and its integration with the intracranial dynamics and metabolism of the brain. This development was clearly demonstrated at the first ICP symposium which was most successfully arranged in 1972 by Hermann Dietz and Mario Brock at the Medizinische Hochschule of Hannover. The widespread interest in ICP problems which was so obviously demonstrated during this meeting evoked the idea that further ICP symposia might be warranted. At a final conference the organizers and members of the advisory board agreed that a second ICP symposium should be arranged two years later, and suggested that it should be held in Lund. This volume contains the papers presented at the Second ICP Symposium held in Lund on June 17-19, 1974. A total of 132 papers were submitted. 102 were accepted and included in the abstract volume which was issued to all participants beforehand. The selection was made by the organizing committee in co-operation with the advisory board and the chairmen.

The papers presented at the Third International Symposium on Intracranial Pressure that was held at the University of Groningen. June 1-3, 1976 are brought together in this volume. After the successful meetings in Hannover and Lund the feeling of the Advisory Board was. that the third meeting should have more clinical implications. and therefore 7 out of the 10 Sessions deal with clinical problems. That there is still a growing interest in the problems of the intracranial pressure appears from the fact that 152 papers were submitted. Unfortunately only 56 could be read. due to lack of time. The selection was made by the members of the Advisory Board. It is a pity that so many good papers had to be rejected because they did not fit in the program. It was decided in a meeting of chairmen and co-chairmen during the symposium that the next congress will take place in 1979. to keep away from the CBF-meeting in June 1977 in Copenhagen and the "Brain-Edema" meeting in 1979 in Bethesda. This fourth symposium will be held in Williamsburg (USA) and prepared by Donald P. Becker. Douglas Miller. Gerald M. Hochwald and Kenneth Shulman.

More than 40 years ago British and German neurosurgeons met in Berlin and Breslau to exchange their experiences, to strengthen their friendly bonds, and to enjoy the attractions of both cities and their surroundings. In 1960 a joint meeting of the Dutch and German societies took place in Rotterdam by invitation of the Nederlandse Vereniging van Neurochirurgen. All who attended this meeting thankfully remember the great hospitality during these unforgettable days. In 1970, by courtesy of the Society of British Neurological Surgeons, German neurosurgeons had the pleasure to become acquainted with the great tradition of British sciences at one of the most famous places during the meeting in Cambridge. These impressions were deepened by visits to other famous sources of British scientific tradition during the European Congress in Oxford in 1975. The critical distance sometimes necessary towards our own discipline is implicit in the major themes of this meeting. Complications following shunting procedures for hydrocephalus have been discussed on the basis of the results of a cooperative study of some German neurosurgical departments. The second main topic was problems and diagnostic errors in computer tomography. The papers presented contain critical considerations about the findings obtained by this method, as well as on its possibilities and limitations. German neurosurgeons felt deeply indebted to their British and Dutch colleagues and wanted to return their kindness at this joint meeting in Berlin. We hope that all participants will retain pleasant memories of the days in this city.

This volume of Advances in Neurosurgery 7 presents the papers held at the Joint Meeting of the American Academy of Neurological Surgery and the "Deutsche Gesellschaft fUr Neurochirurgie" in October 1978 in Munich. This exchange of thoughts on scientific methods in neurosurgery on both sides of the globe, i.e., both in the United States and in Germany, covered a number of different topics in the field of neurosurgery, with special emphasis on the following subjects: Intracranial vascular surgery and specialized neurosurgical techniques used for different operative approaches to the skull, brain, pituitary gland, and peripheral nerves. Contributions to the field of computer tomography, traumatology, functional and experimental neurosurgey, as well as chemotherapy rounded off the broad exchange of thoughts. In particular, the variety of the problems discussed, gives insight into the present state of our special field and shows progress and new points of departure. Special gratitude is expressed to the Springer-\Tedag for its help in editing the Ad­ vances in Neurosurgery, Volume 7. Miinchen, September 1979 EMARGUTH v Opening Oration F. MARGUTH I should like to welcome all of you wholeheartedly to the Joint Meeting of the American Academy of Neurological Surgery and the Deutsche Gesellschaft fUr N eurochirurgie. I welcome especially our collegues from the United States and the ladies.

This book contains the papers delivered at the Fourth International Symposium on Intracranial Pressure, held at Williamsburg, Virginia, USA, June 10-14, 1979. Divided into 12 sessions, they reflect the most recent developments in areas such as head injuries, pressure­ volume studies, cerebrovascular complications, intracranial hemor­ rhage, brain edema, systemic factors and infectious processes, data recording and analysis, CSF formation and absorption, hydroce­ phalus, clinical aspects of ICP monitoring, anesthesia and intra­ cranial pressure, treatment with barbiturates and steroids, and os­ motherapy. The book concludes with a summary of the present state-of-the-art in the field as a whole by Dr. Langfitt. There were two innovations at this Symposium. The first of these was poster sessions, the second, breakfast seminars. This volume contains all papers read plus all those presented as posters, and for this reason contains more pages than the three previous volumes. The organizers wish to thank the Advisory Committee for the work done in paper selection and focus of the Conference. Appreciation is also given to the Chairmen and Co-chairmen of the sessions for the preparation of summary statements. Manuscript preparation was performed by Ms. Lucille Browne, and gratitude is expressed to her. The next Symposium, the Fifth International Conference on ICP, will be held in Japan in 1982. We also wish to acknowledge the technical help of Springer-Verlag and their celerity in producing this volume. The Editors VII Contents Session I. Head Injury Chairman: D. P. BECKER; Co-chairman: I. PAPO 3 Summary . . . . . . . . . . . ..

This volume contains papers presented at the Fifth International Symposium on Intra­ cranial Pressure held on May 30-June 3,1982, in Tokyo, Japan. The Symposium has continued to grow since it began in 1972, and this year it was comprised 121 oral and 46 poster presentations. This considerable number was chosen from the more than 216 abstracts that were received, which made the selection process very difficult. We would like to thank the Program Committee for their efforts. One hundred and fifty-one of the manuscripts are printed here. The classic papers, short communications, and the presentations for the poster sessions here appear together under their appropriate topic heading. There were eleven sessions which spanned the most basic scientific descriptions of ICP dynamics to the most recent clinical advances and debate. Also included are the seven special seminars given by the invited speakers. These spe­ cial seminars were an innovation at this symposium as a means of reviewing the major aspects and history and of projecting the future directions of this expanding field. The organizers wish to thank the Advisory Committee for their guidance and focus, and to express their appreciation to everyone who contributed to the success of this meeting - to the Chairmen and Co-chairmen, to all of the members and participants, and not least of all to our executive staff who worked behind the scenes. We also wish to acknowledge our gratitude to Springer-Verlag for their technical aid and for their prompt publication of this volume.