The Maturation Phenomenon, described by Ito et al. in 1975 [3) on the basis of his to logical observations in the hippocampus as well as other portions of the cerebral hemisphere, refers to the hours or days of delay in the development of pathological changes in various parameters of ischemic injury following the restoration of blood flow to the ischemic brain. There is a direct relationship between the intensity of ischemic insult and the speed and rate of maturation of ischemic injury, a lesser intensity being associated with slower and less severe development of the lesions. The delayed neuronal death of CAl pyramidal cells of the hippocampus [8) is a classic example. In the cerebral cortex, with increasing intensity of the ischemic insult, the maturation phenomenon of ischemic injuries intensifies, seamlessly, from less exten sive to more extensive disseminated selective neuronal necrosis (DSNN), and then further to cerebral infarction upon reaching a critical threshold [1,2,4,6,7). We also have found that following ischemic insults just under the threshold level required to induce infarction, only disseminated selective neuronal necrosis (DSNN) progresses, while following ischemic insults at the threshold level, initially only DSNN develops, followed by the evolution of a gradually enlarging infarcted focus [5, 7). The reporting of this phenomenon boosted research in the field, as it became evi dent that ischemic damage is not a sudden event, but a process potentially susceptible to therapeutic intervention.

It has been well recognized that following an ischemic insult many nerve cells of the brain are not killed outright, but may suffer a "delayed neuronal death" or even recover. This led to the concept of "maturation phenomenon" with its main implication that the maturation of ischemic lesions may provide a "window of opportunity" i.e. a period of time when the injury to neuronal elements is still reversible, and during which an application of proper therapeutic measures might be successful. The symposium on Maturation Phenomenon in Cerebral Ischemia was the first international meeting focussed primarily on this subject and the resulting publication contains presentations and discussionsby prominent researchers engaged in this field. This book should stimulate further research on potential of brain tissue for recovery, and particularly with regard to a functional recovery of neurons suffering from chronic ischemic injury.

The maturation phenomenon, first described by Ito et al. in 1975, refers to postischemic changes that develop hours or days after an ischemic insult. The delayed neuronal death of CA1 pyramidal cells of the hippocampus is a classic example. The report of the phenomenon boosted research in the field, as it became evident that ischemic damage is not a sudden event, but a process potentially susceptible to therapeutic intervention. Since then a growing number of studies have improved our knowledge on mechanisms of cell death and recovery. This volume contains the presentations of the 4th international symposium, held in New Orleans in October/November 1999, grouped in sections covering apoptosis and/or necrosis, neuronal recovery vs. death, and protection against infarction. It outlines the present status of investigations and provides further stimulation for research in this field.

Many nerve cells of the brain which are not killed outright may suffer delayed death or recovery after ischemic insult. This fact has led to the concept of "maturation phenomenon" of neuronal injuries. Since the 1st International Symposium on Maturation Phenomenon in 1990, new developments, particularly in molecular biology, have been rapidly bringing new information about molecular nature and mechanisms of cell death. This book contains the presentations of the 2nd International Symposium held in Tokyo in April 1996. The latest developments in maturation phenomenon and the present status of investigation are described and further stimulation of research in this field is provided.

Brain edema is a simple phenomenon – an abnormal increase of brain tissue volume by the increase of brain tissue water content. However the etiology is not simple and relating to a wide variety of neurological disorders including ischemia, trauma, tumor, hemorrhage and hydrocephalus. It is still a major cause of death in the neurological/neurosurgical ward. This volume is an up-to-date report on progress in brain edema research, diagnosis and treatment, including papers presented at the 12th International Symposium on Brain Edema and Brain Tissue Injury in 2002. Major topics include molecular biology and blood-brain barrier disorders, ischemic and traumatic brain edema, imaging and diagnosis of brain edema, treatment and radiation effect. Various papers in the rapidly growing fields of neuroimaging and molecular medicine are also included.

This fascinating monograph is filled with information formerly found only in periodicals and symposia proceedings. Chapters discuss the different models of cerebral ischemia in use today, including their advantages and disadvantages. This one-of-a-kind resource also contains essential chapters on cellular mechanisms of ion and acid-base homeostases, and energy metabolism of the ischemic brain. It reviews the possible role of lipids, free fatty acids, and free radicals. Four chapters are devoted to neurotransmitters and neuroregulators in cerebral ischemia. This extraordinary work also covers aspects of protection against and resuscitation from cerebral ischemia. An extremely informative volume, this book is an absolute must for every student in the field of cerebral ischemia, as well as the clinician or scientist who is already involved with this worldwide problem.

Because stroke is essentially a disease of the vessels and blood flow, the most fundamental aspects of ischemic blood flow in the brain are under investigation by researchers. Their work was the focus of the sixth in the series of Keio University International Symposia for Life Sciences and Medicine, held in Tokyo in 1999. Selected here are 55 papers from the symposium, covering the buffy coat (glycocalyx) of endothelial cells, the blood-brain barrier and permeability, gene expression, vascular reactivity, dysregulation, inflammatory deterioration, cortical spreading depression, edema, microvascular derangement, and pathology, in ten major sections. The book includes the thought-provoking discussions that followed the presentations, thus providing an invaluable source of up-to-date information not only for researchers investigating microcirculation but also for clinicians implementing the most effective treatment for stroke patients.

Covering neuroscience and rehabilitation strategies, an essential handbook and reference for multidisciplinary stroke rehabilitation teams.

Stroke is thought to be the second biggest killer worldwide, and is responsible for over 5 million deaths per year. Several strategies have been developed to enhance treatment of stroke patients. Multimodal neuroimaging allows physicians to diagnose and evaluate not only the ischemic core but also the vessel pattern and collateral status. Stroke Treatment involves extensive intravenous drug administration. Several new drugs with long lasting efficacy are now being tested in randomized clinical trials. In this context, endovascular treatment is a promising avenue that allows physicians to treat patients in extended time windows especially patients in whom intravenous RTPA has failed. A new era has emerged with new devices called stent retrievers and aspiration techniques, which have demonstrated higher rates of recanalization and clear superiority over previous devices employed in RCTs. The third volume of Frontiers in Neurosurgery presents updated information on ischemic stroke treatment. The volume comprehensively covers the epidemiology, physiology, diagnosis and treatment modalities of stroke. Readers will also find key information on diagnosing and treating rare and lesser known causes of stroke as well as notes about new devices and medical procedures to combat ischemic stroke. This volume is a useful resource for neurosurgery specialists as well as nurses, physiotherapists and caregivers.

This volume is a compilation of papers presented at the Tenth International Symposium on Brain Edema held on October 20-23, 1996, in San Diego, California. This follows the sequence of meetings that was initiated 31 years ago in the First International Symposium held in Vienna. Subsequent symposiums were held in Mainz, Montreal, Berlin, Groningen, Tokyo, Baltimore, Bern, and Tokyo CY okohama). A considerable number of papers was chosen from over 100 papers that were received. The organizers wish to thank the Advisory Committee for the excellent work done in selection of the papers. We also wish to thank all the persons who contributed to the success of the Tenth International Symposium, especially the staff who worked behind the scenes. These papers were reviewed, edited, approved or disapproved by the Editorial Board. Those manuscripts that were felt not pertinent to this publication were not accepted by the Editorial Board. Therefore, the excellent quality of those that are in the book are a reflection of the authors' dedication and work and that of those of the Editorial Board in their review process. For the reader's convenience, the papers are structured according to the various disease processes which are associated with the primary topic: hypertension, hydrocephalus, infection, ischemia, tumor, etc. We do hope that the reader will enjoy the articles and that they will provide an impetus and insight for future work.