Advances in Neurosurgery – serie
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Brain Edema / Cerebello Pontine Angle Tumors
Pathophysiology and Therapy / Diagnosis and Surgery
Häftad, Engelska, 1973
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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.
Meningiomas. Multiple Sclerosis. Forensic Problems in Neurosurgery
Diagnostic and Therapeutic Problems. Misdiagnosis
Häftad, Engelska, 1975
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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.
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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.
Lumbar Disc Adult Hydrocephalus
Proceedings of the 27th Annual Meeting of the Deutsche Gesellschaft für Neurochirurgie, Berlin, September 12-15, 1976
Häftad, Engelska, 1977
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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.
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The 28th annual conference of the German Society for Neurosurgery was held in Cologne, West Germany, from the 18th to the 21st of September 1977. The conference dealt with problems concerning craniocerebral injuries and space-occupying processes in the posterior cranial fossa as well as general topics on clinical practice and research with special attention paid to the work of younger neurosurgeons. This volume is a presentation of the conference results. Within the scope of the general topics, special interest was directed toward the que stion of the current status of cytostatic treatment for brain tumors. In addition to experimental investigations, the results concerning cerebral tumors and medulloblas tomas are reported. Cerebellar tumors represent two further focal points: 1. From the diagnostic viewpoint, specific results from computerized tomography are discussed, especially with regard to the more extensive anatomic difficulties involved in the posterior cranial fossa. 2. With emphasis on cerebellar processes, the results of long-term measurements of intracranial pressure during the postoperative follow-up period are reported.
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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.
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W. SCHIEFER The 31st annual meeting of the Deutsche Gesellschaft für Neurochirurgie was held in Erlangen on May 1 - 4,1980. The numerous participants obviously enjoyed the opportunity to be co me acquainted with the attractive city of gardens, lecture theatres and workshops surrounded by a lovely countryside and a historic environment. The pro gram included a visit to the neighboring city of Nürnberg, to the old Reichsstadt Regensburg and an opening ceremony in the orangerie of the Erlangen palace, where the "Bamberger Ensemble für alte Musik" presented interesting and little-known early music. The annual meeting was held in the newly-built "Kopfklinik" of the University of Erlangen-Nürnberg, which houses the departments of neurosurgery, neurology and ophthalmology. As far as possible, many functions of this hospital were centralized because this has economic advantages and saves personell. Other functional units, such as the operating theatres, the intensive care units, research laboratories and units specific to the individual disciplines remained decentralized and independent. This concept has proved to be a happy solution. At the membership meeting of the Deutsche Gesellschaft für Neurochirurgie, Prof. Dr. K. J. Zülch of Cologne was made an honorary member of this society, of which he is a founding member.
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W.DRIESEN This volume contains the original text of 60 papers delivered at the 32nd Annual Meeting of the German Society for Neurosurgery, held in TUbingen, 22nd to 25th April, 1981. They represent a selection from 91 papers submitted, a third of which had to be excluded on critical analysis. This was deemed necessary on account of costs, and in order to keep the volume of a size and standard usually achieved within the last few years. Three main subjects were considered: 1. changes in methods of investigation and treatment of neurosurgi cal·conditions, brought about by the use of computerised axial tomography (C.A.T .• scanning); 2. papers dealing with fundamental research concerned with normal and abnormal cerebral metabolism; 3. trauma to the vertebral column and spinal cord, and its sequelae; and, 4. free communications. The organisers of this meeting tried, in contradistinction to pre vious custom, to shift the emphasis away from highlighting major communications, and so to remain true to their intention to allow experts in their fields to introduce their subjects and pin-point problems, to which subsequent speakers could then address them selves in detail in their own papers. In my view, this did occur in a meaningful way, although not to perfection; a goal always difficult to attain.
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This volume of ADVANCES IN NEUROSURGERY presents the original texts of 60 papers delivered at the 33rd annual meeting of the German Neuro surgical Society held in Kiel from May 16th to 20th, 1982. These papers represent a selection from some 162 papers submitted and 96 actually given. The selection was made by the society's programme committee, of which Professor W. J. BOCK, Professor H. DIETZ and Professor W. GROTE are also members. I would like to take this opportunity to express my sincere thanks to them for their untiring cooperation. The scientific programme dealt with three main themes: 1. Acute, non-traumatic intracranial hemorrhages, a subject that has always been of importance for neurological surgeons since the ana tomist Giovanni Battista MORGAGNI in 1791 first described in detail the clinical picture and the pathological and anatomical causes of a brain hemorrhage he had observed in his servant. Indeed, at our 31st annual meeting in Erlangen in 1980 "Timing Problems in Sub arachnoid Hemorrhages" was one of the main topics of discussion. For this year's meeting a cooperative study in which 27 university and hospital departments of neurosurgery participated enabled us to look into the causes and the diagnostic and therapeutic measures involved in a great number of cases of intracranial hemorrhage.
CNS Metastases Neurosurgery in the Aged
Proceedings of the 34th Annual Meeting of the Deutsche Gesellschaft für Neurochirurgie, Mannheim, April 27-30, 1983
Häftad, Engelska, 1984
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The computer tomograms of the brain were investigated in 195 patients in whom a primary carcinoma was known to be present. Metastases of bronchial and mammary carcinomas are most frequent. It is not possible to achieve a definite differentiation of brain metastases from known primary tumors. References 1. Kazner, E. , Wende, S. , Grumme, Th. , Lanksch, W. , Stochdorph, 0. : Computertomographie intrakranieller Tumoren. Berlin, Heidelberg, New York: Springer 1981 2. Nadjmi, M. , Piepgras, U. , Vogelsang, H. : Kranielle Computertomo- graphie. Stuttgart: Thieme 1981 3. Penzholz, H. : Die metastatischen Erkrankungen des Zentralnerven- systems bei besartigen Tumoren. Acta neurochir. Suppl. ~, 1968 4. ZUlch~ K. J. : Pathologische Anatomie der raumbeengenden intra- kraniellen Prozesse. In: Handbuch der Neurochirurgie, Bd. III, Hrsg. Krenkel, W. , Olivecrona, H. , Tennis, W. Berlin: Springer 1956 18 Epileptic Seizures in Brain Metastases B. Neundorfer Klinik fUr Neurologie, Medizinische Hochschule LUbeck, Ratzeburger Allee 160, D-2400 LUbeck 1 Epileptic seizures are a frequent symptem ef intracranial space- eccupying lesiens (4).The reperted frequency in the literature var- ies between 13% and-abeut 50%. This apparent discrepancy can be ex- plained by the different cempesitien ef different series with regard to. the patient's age, turner histelegy and lecatien (4). The mest frequently enceuntered finding in patients with symptematic seizures is a primary brain turner: at the tep ef the list eligedendregliemas, astrecytemas and meningiemas - at the bettem glieblastemas. Brain metastases are also.
Extra-Intracranial Vascular Anastomoses Microsurgery at the Edge of the Tentorium
Häftad, Engelska, 1985
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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.
Spinal Cord Tumors Experimental Neurosurgery Neurosurgical Intensive Care
Proceedings of the 36th Annual Meeting of the Deutsche Gesellschaft für Neurochirurgie, Berlin, May 12-15, 1985
Häftad, Engelska, 1986
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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.
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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.
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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.
Stabilizing Craniocervical Operations Calcium Antagonists in SAH Current Legal Issues
Proceedings of the 40th Annual Meeting of the Deutsche Gesellschaft für Neurochirurgie, Würzburg, May 7-10, 1989
Häftad, Engelska, 1990
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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.
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Recent topics of interest in neurosurgery are discussed in this volume, which contains selected papers from an annual meeting of the German Society for Neurosurgery. 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 tumours in childhood. The interdisciplinary aspects of neurosurgical intensive care, particularly electrophysiology and anaesthesia, are also discussed in detail.
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Three topics of major interest for neurosurgeons are covered in this volume of the "Advances in Neurosurgery" series. First, neurosurgical standards of diagnosis and treatment are viewed from several points of view, including the legal one. Secondly, the many aspects of aneurysm surgery are dealt with: timing and grading, monitoring during the operation, post-operative vasospasm, Doppler sonography and new research in subarachnoid haemorrhage. The diagnosis and treatment of malignant gliomas are also 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.
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"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 haematomas, 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.
Cerebellar Infarct. Midline Tumors. Minimally Invasive Endoscopic Neurosurgery (MIEN)
Häftad, Engelska, 1994
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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.
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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.
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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.