The traditional education of the neurosurgeon and duce simultaneous contrast preparations of the ar the clinician working in related specialties is based teries and veins and thus obtain a complex photo on their presumed knowledge of the macroscopic graphic representation of the structures of the prep anatomy of the brain as traditionally taught. Most aration. neurosurgical textbooks, therefore, provide macro The manuscript and drawings were completed in the scopic views of sections of the operative site. The years 1974-1976 after almost two decades of neu literature that has accumulated in recent years on rosurgical work. The data worked out in the early the subject of microneurosurgical operations also stages (Chapter 1 in particular) were used by the follows this principle. author as the basis for teaching programmes at the For some years, however, the customary macro University of Giessen. Chapters 2-7, dealing with scopic representation of the anatomy of the brain the operative technical aspects, were produced after has been inadequate for the needs of the neurosur mid-1975 and used by the author as the basis for geon using refined modern operative techniques. microneurosurgical teaching of his colleagues at the Furthermore, despite their detailed presentation, University of Freiburg. stereotactic atlases are also insufficient for neuro My thanks are due to Doz. Dr. E.

Like the author's previous publications - "Atlas of the Department of Radiodiagnostics, University of Topographical Anatomy of the Brain and Surround Freiburg; Prof. Dr. K. Kendel, Director of the Neu ing Structures" (1978) and "Microsurgery of the rological Clinic, District Hospital Lahr, and his col Brain" (1980) - this book is based on over ten league Dr. G. Reinshagen; Prof. Dr. J. Dichgans, years' experience in microsurgery in addition to Director of the Department of General Neurology, more than ten year's experience in the performance University of Tiibingen; and Prof. Dr. K. Voigt, Di of macrosurgical operations in the region of the rector of the Department of Neuroradiology, Uni spine and spinal cord. versity of Tiibingen, for undertaking a considerable The author is indebted to Prof. G. Ya{sect}argil for en amount of the diagnostic work in the clinical cases couragement in carrying out intramedullary opera described in this book. Apart from a few excep tions. Discussions with R.B. Cloward and study of tions, mentioned in the course of the book, myelo his well-known publications provided important ini grams and recently also computertomograms in tiatives in relation to the adoption of microsurgical cases of spinal disease were carried out mainly in dimensions in ventral approaches to the craniospinal these departments. As in the previous volumes, the junction and to the cervical spine, although the ac topographical anatomical examinations were sup tual fusion procedures are - just as orthopaedic ported by Prof. Dr. J.

A description of cerebral veins under operative versely, where there are large arterial vessel stems (at the base of the brain) the veins somewhat lose their technical aspects is practically a description of opera significance. They become important again in the tive approaches and their obstruction by cerebral region of the basal Dura, the Tentorium, and the Falx veins. It is this which constitutes the major difference but (with the exception of the region of the Sinus between arteries and veins. The arteries of the brain originate from only four large vessel stems, which cavernosus) away from the large arterial stems. This justifies writing a microneurosurgical textbook exclu bridge the CSF space and then run along the surface sively under the aspect of the cerebral veins. of the brain or inside the brain. Arterial vessels hardly interfere with operative approaches, even in the deep That we know so much about cerebral veins is due CSF spaces such as the Sylvian fissure, the Tentorium primarily to the work of neuroradiologists. It is not fissure, and the ventricle system. Veins, on the other the objective of the present volume to provide a hand, can appear in almost every location of the brain compreherisive and comparative survey of the large as so-called bridging veins. They are extremely vari number of individual results of attempts at establish able and can bloc~ the approach to deep CSF spaces ing vein types.

Thisbookispublishedintwovolumes. Velum medullare posterior in the area of the 4th Inthisfirstvolume, anattemptismadetogiveyoung ventricle, including the choroidpoint ofthe PICA, neurosurgeons methodical instruction in the dissec canbestudiedexactly. Theseexampleswerechosen tion of formaldehyde-preserved brains. This book, becauseexacttopographicalknowledgeoftheseves however, isnotintendedtobetakenasatextbookon sel-richstructuresisofteninadequate;andwhenusing modernoperativetechniques, increasingly more op anatomy. Conventionalpresentationsoftheanatomy ofthebrainmustpresent, stepbystep, theindividual erationsareperformedinjusttheseparticularareas. systemsoftheorganaccordingto itsdevelopmental These dissections compose the content of the first and functional aspects, e. g. cortex, limbic system, volume. basal ganglia, brainstem, and cerebellum. Because The second volume is intended for experienced duringasingleoperationtheneurosurgeon issome neurosurgeonswhoperformcomplexoperationsdeep times confronted with all the various systems, it is insidethebrain. Someoftheseoperations have be necessarytoperformbraindissectionsfromtheview come standardized, e. g. theopeningofthesylvian point of operative approaches. Therefore, in this fissure withoperations intheareaofthe Insulaand worktheattemptismadetokeepcertainindividual cranial base. Other complex operations are per surfacestructures, e. g. theGyruspraecentralisintact formed seldom eventoday, e. g. approaches to the until the end of the dissection so that the relative 3rdventricle, Velum interpositum, lateralventricle, topographicalpositionsofsurfaceanddeepstructures Cisterna tecti, Lobulus quadrangularis cerebelli, to can be made discernable. For these reasons, it is namejustafew. Beforesuchoperations, itis advis advisabletoviewthesurfacestructuresofthebrainin able(theauthorstilldoessooccasionally)toorientate relationship to the skull, but then to start with re oneself on a formaldehyde-preserved brain. It is movingthebloodvesselsandleptomeningessothatin shownhowonaformaldehyde-preservedbrain, even this waythe skeletonizedorgan is dissected step by thoughitdoesnotprovidetherealconditionsofalive step, because in the preserved vascular system, the brainunderthe operative microscope, the most im structures are only partially recognizable and thus portant topographical relationships can be recog confusing. Forthisdissectiontwoorgansareneeded. nized. Inthe first dissection, thecerebrum andcerebellum Bothvolumesaretheresultofaone-yeardissection are studied. These the young neurosurgeon should course for colleagues meeting twice a week in our havebecomefamiliarduringhisinitialtraininginthe clinic.

In the previous volume, "Differential Approaches in - if approach is hindered through such variants, or - if the lesion itself has a close relationship to impor- Microsurgery of the Brain", the particularly prob lematical operations in the depth of the brain around tant vessels, for example, if arteries penetrate or the brainstem were covered. Even more than in other are just adjacent to a meningioma. operations on the brain, it was important here to decide before the operation which from several pos On the basis of this method, it was obvious to first sible approaches would be chosen. Therefore in this present the description of the veins and then to con present volume, it was obvious to try to describe sider the arteries and not to choose the direction of microsurgical operations of the brain primarily under the blood flow in the image analysis, as is usually the aspect of preoperative planning. This is done by done. Only then can one judge which problems might presenting the usual daily preliminary discussions be encountered. Certainly only a part of the suspected which have taken place in the Freiburg Clinic for the problems will show up during the operation. How last ten years. On the day before surgery, these ever, in view of the great number of possible difficul discussions are always carried out according to the ties, one should also be prepared for rare complica same principle: tions.

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series of Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. This series was fust discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathers of the series being Jean Brihaye, Bernard Pertuiset, Fritz Loew and Hugo KrayenbUhl. Thus were established the principles of European co operation which have been born from the European spirit, flourished in the European Association, and have throughout been associated with this series. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publi cation of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the fust part of each volume.

Preoperative Magnetic Resonance Imaging allows now a better analysis of the relationship between intracranial tumors and the surrounding brain tissue. Even very small deepseated tumors can be identified during the operation by intraoperative ultrasound. These technological advances have had a great influence on indications, planning strategies and microsurgical techniques. The author shows the functional anatomy of the brain with the eye and the mind of a microsurgeon and demonstrates well known topographical relationships under the aspect of an utmost gentle operative approach.