Topics in Neurosurgery – serie

This volume represents the proceedings of the third in a series of annual inter­ national symposia. The first, The Neuroregulation of Autonomic, Endocrine, and Immune Systems, was held in Indianapolis in the fall of 1985. The second, Psychological and Biological Approaches to the Understanding of Human Disease, was held in Bielefeld, Germany in the fall of 1986. The theme of this series concerns the communication between the central nervous system and the other major systems of the body, and the purpose is to monitor the frontiers of research into these neuronal/hormonal regulatory interactions and their application to medicine. The present volume deals with the role of peptides and amino acids in these information transfer processes. Great strides have been made in exploring the important role of amino acids and pep tides in neuroregulation, and the ongoing biotechnology revolution promises signi­ ficant scientific and medical advances throughout the next decade and beyond. The work described in this volume captures the great excitement and pro­ mise of this biomedical renaissance. This meeting was cosponsored by Searle/ Monsanto and Washington University and held in St. Louis in the early fall of 1986. A major contributor to these proceedings was Dr. Thomas O'Donohue whose chapter deals with his work in characterizing the endogenous ligands for the PCP and sigma opioid receptors. Tom's personality and career personi­ fied the dedication of this series to the principle of a broad multidisciplinary approach to scientific problems.

Ronald Brisman, M.D. This book will discuss three areas where the The multiplicity of procedures with varying neurosurgeon may provide an important degrees of risks and benefits sometimes re­ contribution to the relief of intractable pain: quires a sequential approach, but always an trigeminal and other facial neuralgias, chronic individual one, matching an appropriate treat­ noncancer pain, and cancer pain. By one ment plan or procedure for a particular patient intervention, the neurosurgeon often may pro­ at a specific time in his or her illness. vide long-lasting pain relief. New techniques, The neurosurgical chapters in this book which have developed since the 1970s and represent my experience with several hundred continue to evolve, dominate the neurosur­ patients during a 12-year period from 1975 gical armamentarium because they are not only through 1987. I have relied heavily on the effective, but safe. These include percutaneous works of others, which have been quoted from radio frequency electrocoagulation for trigem­ the neurosurgical literature, but this book is inal neuralgia, spinal stimulation for chronic not meant to be encyclopedic. noncancer pain, and intraspinal morphine in­ At least as important as knowing when to fusion for cancer pain. operate is knowing when not to do so, and this Sometimes a procedure relieves pain but the is particularly true of the treatment of pain. pain recurs; it may be necessary to repeat the Most patients with pain do not require neuro­ procedure, which in the case of radiofrequency surgical intervention.

As in any multiauthored textbook penned by When I was first approached by the publisher of this volume, Martinus Nijhoff, Boston, I writers of diverse backgrounds and interests, explored the possibility of writing a personal Modern Stereotactic Neurosurgery to some monograph on contemporary stereotactic extent suffers from incompleteness. Future surgery. After a review of available literature, volumes no doubt will include many additions several aspects became apparent. First, no cur­ from other authors who also are important rent, readily accessible, multiauthored text de­ specialists in the field. Because not all authors signed to survey the field was available. Those write in the same style (or even language), we books that were available tended to heavily have attempted to achieve a more cohesive text emphasize theory, physiology, and anatomy. in the editorial process. Each chapter has been Second, stereotactic surgeons were considered subdivided into pertinent headings for easier abstruse and for too long were relegated to a reference. Because of my own background, status outside of the mainstream of neuro­ some readers will note an Americanization (as surgery. This attitude probably reflected the opposed to anglicization) of the chapters. insufficient explanation of the practical uses While many chapters comprise primarily sum­ and advantages of stereotactic technique. maries of the authors' work within the field, Third, in recent years, the field has expanded each author was encouraged to review the liter­ so rapidly that it has become a major compo­ ature in that discipline if appropriate.

Ronald Brisman, M.D. This book will discuss three areas where the The multiplicity of procedures with varying neurosurgeon may provide an important degrees of risks and benefits sometimes re­ contribution to the relief of intractable pain: quires a sequential approach, but always an trigeminal and other facial neuralgias, chronic individual one, matching an appropriate treat­ noncancer pain, and cancer pain. By one ment plan or procedure for a particular patient intervention, the neurosurgeon often may pro­ at a specific time in his or her illness. vide long-lasting pain relief. New techniques, The neurosurgical chapters in this book which have developed since the 1970s and represent my experience with several hundred continue to evolve, dominate the neurosur­ patients during a 12-year period from 1975 gical armamentarium because they are not only through 1987. I have relied heavily on the effective, but safe. These include percutaneous works of others, which have been quoted from radio frequency electrocoagulation for trigem­ the neurosurgical literature, but this book is inal neuralgia, spinal stimulation for chronic not meant to be encyclopedic. noncancer pain, and intraspinal morphine in­ At least as important as knowing when to fusion for cancer pain. operate is knowing when not to do so, and this Sometimes a procedure relieves pain but the is particularly true of the treatment of pain. pain recurs; it may be necessary to repeat the Most patients with pain do not require neuro­ procedure, which in the case of radiofrequency surgical intervention.

This volume represents the proceedings of the third in a series of annual inter­ national symposia. The first, The Neuroregulation of Autonomic, Endocrine, and Immune Systems, was held in Indianapolis in the fall of 1985. The second, Psychological and Biological Approaches to the Understanding of Human Disease, was held in Bielefeld, Germany in the fall of 1986. The theme of this series concerns the communication between the central nervous system and the other major systems of the body, and the purpose is to monitor the frontiers of research into these neuronal/hormonal regulatory interactions and their application to medicine. The present volume deals with the role of peptides and amino acids in these information transfer processes. Great strides have been made in exploring the important role of amino acids and pep tides in neuroregulation, and the ongoing biotechnology revolution promises signi­ ficant scientific and medical advances throughout the next decade and beyond. The work described in this volume captures the great excitement and pro­ mise of this biomedical renaissance. This meeting was cosponsored by Searle/ Monsanto and Washington University and held in St. Louis in the early fall of 1986. A major contributor to these proceedings was Dr. Thomas O'Donohue whose chapter deals with his work in characterizing the endogenous ligands for the PCP and sigma opioid receptors. Tom's personality and career personi­ fied the dedication of this series to the principle of a broad multidisciplinary approach to scientific problems.