Madjid Samii – författare

The request from Professor Jörg Klekamp for me to write the foreword for this monograph was an appealing challenge. Prior to the era of microneu- surgery, I was firmly involved in the surgery of spinal lesions, and achieved surgical removal of spinal arteriovenous malformations (AVMs) on 12 - tients in the years between 1960 and 1965. Microneurosurgical techniques were introduced in Zurich in 1962, and since then I have applied these techniques to the exploration of the various spinal lesions: 182 herniated discs, 78 spinal cord AVMs, and 263 spinal tumors (46 epidural, 94 ext- medullary, and 123 intramedullary tumors). These have been published in a preliminary paper only, for I was unable to accomplish completion of the planned Volume V in my Microneurosurgery series within an adequate time frame. I therefore admire the achievement of Klekamp and Samii, who present to us a most comprehensive work. This monograph is outstanding in many aspects, providing an overview of the clinical experiences gained in a single neurological institution over a period of 25 years between 1978 and 2003, consisting of 1081 spinal tumors treated in 868 patients, with 973 operations (intramedullary tumors in 198 patients, extramedullary tumors in 446 patients, and epidural tumors in 329 patients). The entire cohort of patients was explored surgically by app- ing microsurgical techniques.

The request from Professor Jörg Klekamp for me to write the foreword for this monograph was an appealing challenge. Prior to the era of microneu- surgery, I was firmly involved in the surgery of spinal lesions, and achieved surgical removal of spinal arteriovenous malformations (AVMs) on 12 - tients in the years between 1960 and 1965. Microneurosurgical techniques were introduced in Zurich in 1962, and since then I have applied these techniques to the exploration of the various spinal lesions: 182 herniated discs, 78 spinal cord AVMs, and 263 spinal tumors (46 epidural, 94 ext- medullary, and 123 intramedullary tumors). These have been published in a preliminary paper only, for I was unable to accomplish completion of the planned Volume V in my Microneurosurgery series within an adequate time frame. I therefore admire the achievement of Klekamp and Samii, who present to us a most comprehensive work. This monograph is outstanding in many aspects, providing an overview of the clinical experiences gained in a single neurological institution over a period of 25 years between 1978 and 2003, consisting of 1081 spinal tumors treated in 868 patients, with 973 operations (intramedullary tumors in 198 patients, extramedullary tumors in 446 patients, and epidural tumors in 329 patients). The entire cohort of patients was explored surgically by app- ing microsurgical techniques.

It will enable neurosurgeons in the initial years of training to understand and become familiar with the main steps in surgical management while simultaneously providing their senior colleagues with details and technical tips that will help to improve treatment results.

Syringomyelia has fascinated neurologists and neurosurgeons for decades, if not for centuries. The slowly progressing cystic cavitations of the spinal cord have led scientists and clinicians to various pathophysiological hypotheses and treatment strategies. Until recently, no clear concept existed as to what caused a syrinx and how and when a particular patient should be treated. The introduction of magnetic resonance imaging (MRI) has revolutionized our view of syringomyelia. For the first time, we are able to diagnose a syrinx before it produces clinical symptoms, and we can follow the course of the syrinx before and after surgical treatment with a noninvasive method. This has led to a huge amount of information not available to previous scientists. Nevertheless, pathophysiology and treatment are still contro­ versial. The aim of this book is to give a guideline on how to approach a patient with a syrinx. Based on clinical experience, we have modified our strategies repeatedly in an attempt to improve clinical results. We have developed a treatment concept, evolved out of 20 years of clinical and experimental work, which has proven to be a solid basis for our decision making. Clinical courses, surgical indications, tech­ niques, and postoperative results are discussed for each of the different pathologies known to be associated with syringomyelia. In this manner, we hope to give a co­ herent overview on all aspects of syringomyelia, which should help physicians to counsel and treat patients with this fascinating but also potentially devastating dis­ ease.

The region of the skull base was long considered a surgical barrier because of its complex anatomy. With few exceptions, the region immediately beyond the dura or bony skull base constituted a "no man's land" for the surgeon working from the other direction. A major reason for this was the high morbidity associated with operative procedures in that area using traditional dissection techniques. This situation changed with the advent of the operating microscope. Used initially by ear, nose and throat specialists for resective and reconstructive surgery of the petrous bone and parana sal sinuses, the operating microscope was later introduced in other areas, and neurosurgeons began using it in the mid-1960s. With technical equality thus established, the groundwork was laid for taking a new, systematic, and interdisciplinary approach to surgical problems of the skull base. Intensive and systematic cooperation between ear, nose and throat surgeons and neurologic surgeons had its origins in the departments of the University of Mainz bindly supported by our chairmen Prof. Dr. Dr. hc Kurt Schiirmann (Department of Neurosurgery) and Prof. Dr. W. Kley (Depart­ ment of Ear, Nose and Throat Diseases, Head and Neck Surgery). The experience gained from this cooperation was taught in workshops held in Hannover from 1979 to 1986, acquiring a broader interdisciplinary base through the participation of specialists from the fields of anatomy, patholo­ gy, neuroradiology, ophthalmology, and maxillofacial surgery.

A different kind of book! The clivus of skull base is an area difficult to reach in neurosurgery, otorhinolaryngolo- gy, maxillo-facial surgery, plastic surgery, reconstructive surgery, and orthopedic surgery. It is for this reason that the various specialities gave found different approaches for different operations.

Although surgery of the skull base still represents a frontier involving different specialties, it is increasingly being accepted and recognized as a special area po­ sing both unique diagnostic and surgical challenges and specific requirements. This is the prime reason that colleagues involved in the management of skull base processes need special training stressing the different surgical approaches required either at different times or to reach the different areas of this intriguing anatomi­ cal landmark. Although the advent of microsurgical techniques and advanced diagnostic mo­ dalities - high-resolution computed tomography, magnetic resonance imaging (MRI) and MR-angiography, and supers elective endovascular protocols - in the last 25 years has brought significant improvements, such as the recent advances in endovascular treatment, a number of different kinds of limitations still persist. This is especially so in the case of skull base meningiomas, the pathological entity most frequently affecting this area which the neurosurgeon is confronted with in daily practice. Besides understanding the intrinsic characteristics of the different pathological entities which involve the skull base, it is the responsibility of physi­ cians to know and employ the expanded neurosurgical options in the most effecti­ ve and appropriate way.

There is no question that the topic of this meeting in Seeheim, Germany, on intracranial and intralabyrinthine fluids is pertinent. This was the first international meeting at which these two closely-related topics were addressed together. Combining the clinical and research aspects of fluid and pressure regulation in the intracranial and the intralabyrint­ hine compartments as well as discussions on the clinical implications of abnormal fluid pressure was an excellent idea. The presentations and discussions of both the clinicians and basic scientists who participated proved that the concept of having such a combined focused gathering was both original and relevant. The two topics of the meeting in Seeheim have much in common. Maintaining both the intracranial pressure (lCP) and the intralabyrinthine pressure within normal limits is important for the normal functions of both the central nervous system and the ear. The intracranial space and the intralabyrinthine space are closed compartments that communicate with each other in an intricate manner. Deviations from normal intracranial pressure result in specific symptoms and signs. Medical problems related to elevated intracranial pressure vary from subtle to severe. Accumulated knowledge indicates that there are adverse effects from even relatively small elevations in ICP. Elevations in ICP may cause injuries to the brain and the ear. Abnormal pressure in the ear may cause abnormal function and injury. Maintaining the intracranial pressure within normal limits depends on a normally functioning pressure regulation.