Cerebrospinal Fluid And The Brain Edemas

A workshop on Dynamic Aspects of Cerebral Edema was organized to pro vide an opport~nitY,for interdisciplinary and detailed consideration of this subject, so crucial in neurology and neurosurgery. The previ ous workshops were held in Vienna in 1965 and in Mainz in 1972. In the meantime, our ideas on mechanisms of resolution of cerebral edema had been changing drastically. Controversy had arisen regarding the role of biogenic amines in the development of edema. Active work in several centers had indicated the possibility of a reversible compo nent in edematous changes associated with ischemia, the control of which could be of therapeutic significance in the problem of stroke. It was felt that a thorough discussion, at this time, by those involv ed in these various studies should help to resolve the controversies, to crystallize the implications of the new findings, and to evaluate their application for patient care. In preparing the proceedings for publication we have edited the manu scripts and selected the discussions with an aim to highlight new find ings, to make this volume readable, and to eliminate duplication. We gratefully acknowledge financial support from the institutions and organizations previously listed. Many individuals contributed to the success of the workshop and the preparation of the proceedings for publication. Doctors J.B. Brierley, I. Klatzo, H.J. Reulen, and A.G.

The Symposium on Brain Edema has been organized by the Osterreichische Arbeitsgemeinschaft fur Neuropathologie and by the Problem Commission for Neuropathology of the World Federa tion of Neurology. We would like to express our thanks to Dr. L. van Bogaert, president of the W.F.N., for his great interest in the design of this conference and for his energetic support. One of the aims ofthe Problem Commission for Neuropathology has been to contribute to the advances in various problems which are becoming ripe for elucidation by experts in different fields. The idea of the Symposium on Brain Edema has as its background a compelling necessity to elucidate this subject which is clinically so important and neuropathologic ally so poorly understood. It was hoped that this could be achieved by a multidisciplinary approach involving a variety of aspects to be discussed and correlated. Brain edema, being an abnormal cerebral condition, belongs basically to the sphere of neuropathology, but to be successful in our endeavors we had to apply neuropathology in its most modern and widest terms. By this we understand that such neuropathology includes the study of all abnormal phenomena in the nervous tissue related to the structural alterations, and by "structural" we mean not only tissual or cellular ones but also changes on ultrastructural and molecular levels. Thus we needed close and integrated coopera tion of experts in fields such as neurohistology, histochemistry, electron microscopy, neurochemistry, and neurophysiology.

This comprehensive and authoritative text covers the anatomical and physiological aspects of cerebrospinal fluid. Also includes material on differential diagnosis, AIDS, neuro-oncology, psychiatric disorders, and the composition and clinical examination of cerebrospinal fluid, including a detailed discussion on the treatment of complications of the lumbar puncture.

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 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.

This issue contains the proceedings of the most recent Inter national Symposium on Brain Edema, the 5th in a series of confer ences starting 1965 in Vienna. The ever since increasing interest in this field may not only result from the fact that - in clinical terms - the problem is not solved yet, but also from the many fascinating physiological and biochemical questions remaining. Moreover, the rapid progress of technical, physiological and bio chemical developments provides a permanent challenge to probe the subject with better and better resolution. The current proceedings provide many examples. It is safe to assume, that the history of brain edema research is familiar to most of its participants. Therefore, suffice it to remark that since the first histopathological recognition of brain edema as a separate entity among the multitude of intracranial space occupying lesions, progress in the understanding of its pathogenesis has not been straightforward. On the contrary, it has been complicated by confusing notions and concepts, some of which may have resulted from the elusiveness of the edematous changes in early histological studies, due to the inadequacy of the light microscope. Although brain edema occurs concomitantly in many pgtho10gica1 conditions of the brain, it has been suggested that its role is collateral only. Nevertheless, the potential of brain edema as a space occupying lesion is not trivial, since it raises intracranial pressure and eventually may result in lethal cerebral herniation.