M. Samii – författare

Magnetic resonance imaging (MRI) has revolutionized our understanding of many neurological diseases. This is the first textbook on syringomyelia by a single team of authors covering all aspects of this disease since the introduction of this method. Based on a pathophysiological concept which is presented in the opening chapters of this book, we provide guidelines for diagnosis and surgical treatment of patients with syringomyelia. Each pathological condition syringomyelia may be associated with is described in a separate chapter in which clinical presentations, neuroradiological features, neurophysiology, and surgical indications and techniques are covered. Finally, a detailed analysis of postoperative results is given. Special sections are devoted to patients after treatment has failed. This book should help any physician dealing with a patient to initiate the appropriate diagnostic tests and studies to reach a diagnosis as to what has caused the syrinx.

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.

As a result of its structure, the skull base forms a borderline between different medi­ cal and surgical specialties.

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.

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.