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  • 1
    Electronic Resource
    Electronic Resource
    Cytogenetic and in situ DNA-hybridization studies in intracranial tumors of a patient with central neurofibromatosis
    Amsterdam : Elsevier
    Cancer Genetics and Cytogenetics 38 (1989), S. 171 
    Details
    ISSN: 0165-4608
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://linkinghub.elsevier.com/retrieve/pii/0165-4608(89)90579-7
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  • 2
    Electronic Resource
    Electronic Resource
    Versorgung des Schädel-Hirn-Traumas im neurochirurgischen Zentrum (1996)
    Springer
    Der Chirurg 67 (1996), S. 1114-1122 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Brain injury ; Traumatic intracranial hematoma ; Intracranial hypertension. ; Schlüsselwörter: Schädel-Hirn-Trauma ; traumatische intrakranielle Blutung ; Hirndrucktherapie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die aktive und intensive Behandlung eines Patienten mit Schädel-Hirn-Trauma (SHT) erhöht seine Chance auf Erholung deutlich im Vergleich zum Spontanverlauf. Trotz rückläufiger Morbidität und Letalität hat sie aber wegen der Irreversibilität einmal stattgehabter cerebraler Schäden Grenzen. Im Mittelpunkt steht die Vermeidung primärer und sekundärer Schäden durch die Beherrschung einer intrakraniellen Druckerhöhung als Folge von Blutungen, Hirnschwellung und Liquorzirkulationsstörungen. Als Eckpfeiler der Therapie haben sich bei traumatischen Blutungen ihre operative Evakuation, beim Ödem die Gabe von Mannitol und eine milde Hyperventilation und beim Liquorüberdruck eine therapeutische Liquordrainage etabliert. Bei therapieresistenten Hirndrücken kann auf Barbiturate und auf kurzzeitige, aggressive Hyperventilation zurückgegriffen werden.
    Notes: Summary. Aggressive treatment of patients with severe head injury increases the chance for survival and good functional outcome in most cases. To prevent irreversible cerebral lesions, the key point of treatment is the management of intracranial hypertension caused by intracranial hematomas, brain edema and impaired circulation of cerebrospinal fluid (CSF). Therapeutic standards are surgery of traumatic hematoma, osmotherapy and mild hyperventilation for brain edema, and CSF drainage. In highly elevated intracranial pressure (ICP) administration of barbiturates and forced hyperventilation can be considered.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050112
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  • 3
    Electronic Resource
    Electronic Resource
    Osteoplastic frontal sinusotomy and extradural microsurgical repair of frontobasal cerebrospinal fluid fistulas (1996)
    Springer
    Acta neurochirurgica 138 (1996), S. 245-254 
    Details
    ISSN: 0942-0940
    Keywords: Cerebrospinal rhinorrhoea ; ethmoid sinus ; frontal sinus ; head injury ; skull base tumours
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The choice of the surgical approach and operative technique for the management of cerebrospinal fluid (CSF) fistulas of the anterior cranial fossa are still a controversially discussed topic. Although “extracranial” approaches through the paranasal sinuses are becoming increasingly more popular among otolaryngologists and maxillo-facial surgeons, most neurosurgeons traditionally prefer the “intracranial” repair of CSF fistulas by a craniotomy. We present an approach through the frontal sinus for the repair of dural defects behind the posterior wall of the frontal sinus and at the floor of the anterior cranial fossa. The operative procedure comprises the following main steps: 1) exposure of the anterior wall of the frontal sinus by a bicoronal incision; 2) excision of the anterior wall without frontal burr holes; 3) bilateral removal of the posterior wall of the fronal sinus; 4) extradural inspection of the dura behind the frontal sinus and above the cribriform plate, ethmoidal roof, and orbital roof bilaterally; 5) closure of dural tears by direct suture and a periosteal graft; 6) reinsertion of the anterior wall of the frontal sinus and fixation with titanium micro plates. Twenty-five patients operated upon using this technique are described. The aetiology of the frontobasal lesion was traumatic in 23, and an ethmoid carcinoma in two. In all patients, the dural fistulas were successfully repaired during the initial procedure. One patient died from sudden circulatory arrest after an uneventful postoperative course of nine days. Otherwise, there were no postoperative complications. This technique affords atraumatic extradural inspection and repair of dural fistulas bilaterally behind the frontal sinus, and above the cribriform plate and the ethmoidal and orbital roofs with none or minimal brain retraction. It therefore allows early repair of CSF fistulas also in patients with severe brain injury. Although we consider the extradural closure of fistulas the method of choice, this approach also allows for a combined extradural-intradural procedure, thus enabling the surgeon to treat associated intradural pathologies, such as traumatic lesions or tumours of the frontal cranial base.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01411734
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  • 4
    Electronic Resource
    Electronic Resource
    Morphological changes following experimental intraventricular haemorrhage and intraventricular fibrinolytic treatment with recombinant tissue plasminogen activator (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 561-567 
    Details
    ISSN: 1432-0533
    Keywords: Key words Cerebral haemorrhage ; Intraventricular haemorrhage ; Ependyma ; Tissue plasminogen activator
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Intraventricular haemorrhage (IVH) occurs in up to 50% of patients with primary intracerebral haemorrhage and aneurysmal subarachnoid haemorrhage. It is a significant and independent contributor to mortality and morbidity in these intracranial haemorrhages. Using a model of isolated IVH, we assessed the morphological changes induced by intraventricular bleeding and investigated the effects of intraventricular fibrinolytic treatment following IVH. IVH was induced in 32 pigs by intraventricular infusion of 10 ml autologous blood along with thrombin. The treatment group received an intraventricular injection of 1.5 mg (1 mg/ml) tissue plasminogen activator (tPA) following the injection of blood. The placebo group received the same volume of normal saline. Morphological examinations of the brains were carried out 7 days and 6 weeks following IVH. The ventricles were incompletely filled with blood and significantly enlarged in the placebo group 7 days after the IVH. In contrast, no residual intraventricular clots were visible in the animals treated with tPA, and the diameters of the lateral ventricles had returned to normal within 7 days. Marked losses of the ependymal covering of the ventricular walls were found in the placebo-treated animals, while the ependymal layer was largely intact in the animals treated with tPA. No haemorrhages induced by tPA were observed. The results indicate that intraventricularly administered tPA significantly enhances the lysis of intraventricular blood clots, accelerates the resolution of acute posthaemorrhagic hydrocephalus, and preserves the integrity of the ependymal layer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010000219
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  • 5
    Electronic Resource
    Electronic Resource
    Bilateral chronic subdural haematomas following traumatic cerebrospinal fluid leakage into the thoracic epidural space (1993)
    Springer
    Acta neurochirurgica 120 (1993), S. 92-94 
    Details
    ISSN: 0942-0940
    Keywords: Cerebrospinal fluid leakage ; chronic subdural haematoma ; intracranial pressure ; spinal injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This report describes a patient who developed bilateral chronic subdural haematomas after a stab injury to the thoracic meninges causing prolonged cerebrospinal fluid leakage into the epidural space. Diagnostic findings and therapeutic management are presented and possible pathogenic mechanisms are discussed. This case suggests that patients who have symptoms or signs of increased intracranial pressure after a penetrating spinal injury should be studied for subdural haematoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02001476
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  • 6
    Electronic Resource
    Electronic Resource
    Four-Year Experience with the Routine use of the Programmable Hakim Valve in the Management of Children with Hydrocephalus (1998)
    Springer
    Acta neurochirurgica 140 (1998), S. 1127-1134 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Cerebrospinal fluid; hydrocephalus; low ICP syndrome; pressure adjustable valve; slit ventricle syndrome; underdrainage.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  Objective. Cerebrospinal fluid (CSF) over- and underdrainage symptoms are frequent sequelae of shunt placement in patients with hydrocephalus, sometimes requiring repeated operations. To achieve more adequate CSF drainage, the non-invasively programmable Hakim valve has been developed. Because the clinical experiences with this valve so far are confined to adults, we describe our experiences with the routine use of the programmable Hakim valve in childhood hydrocephalus.  Method. Sixty children (mean age of 3.4 years) with hydrocephalus of various aetiologies have been shunted with the programmable Hakim valve. In the majority of cases, initial opening pressures of between 100 and 120 mm H2O were selected. The mean follow-up period was 2.1 years.  Results. Thirty-three readjustment of the pressure setting of the valve were performed in 20 children because of CSF overdrainage (low intracranial pressure syndrome n=13, slit ventricle syndrome n=2, hygroma n=1), CSF underdrainage (n=3) and CSF leakage through the operation wound (n=1). The symptoms of inadequate CSF drainage were cured in 18 of the 20 children. The necessity for valve readjustments was independend of the aetiology of the hydrocephalus. Thirty-one complications requiring repeated operation occurred during the follow-up period, accounting for an annual complication rate of 24.6%. Three complications were valve-related.  Conclusion. In the majority of cases, the programmable Hakim valve allows the successful management of symptoms related to CSF over- and underdrainage by non-invasive change of the initial pressure setting of the valve. Therefore, the programmable Hakim valve should be considered as an alternative to non-programmable valves of advanced design.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050226
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  • 7
    Electronic Resource
    Electronic Resource
    Planning and surgical strategies for early management of vertebral artery and vertebrobasilar junction aneurysms (1995)
    Springer
    Acta neurochirurgica 134 (1995), S. 60-65 
    Details
    ISSN: 0942-0940
    Keywords: Anatomical landmarks ; cerebral aneurysms ; posterior circulation ; transcondylar approach
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Selection of the approach and technique for surgical repair of aneurysm of the vertebrobasilar artery system is mainly based on angiographic features. This report emphasizes that planning the surgical procedure should also include preoperative evaluation of the individual skull base configuration, as well as the relationship between aneurysm site and surrounding bony structures. These features are evaluated on thin slice CT scans using bone tissue algorithms and are particularly important for adequate exposure of distal vertebral artery (VA) or midline aneurysms, because these cases require drilling of the jugular tubercle. For the use of lateral approaches, the surgeon must be familiar with the extradural and intradural anatomy of the foramen magnum region and may rely on at least five anatomical landmarks for orientation during surgery: 1) the dural entrance of the vertebral artery; 2) the posterior condylar emissary vein; 3) the medial rim of the distal sigmoid sinus; 4) the hypoglossal canal; 5) the jugular tubercle. To increase the safety of the procedure, the authors recommend an individualized tailoring of the surgical approach according to the variable morphological situation of each patient.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01428505
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  • 8
    Electronic Resource
    Electronic Resource
    Effect of recombinant tissue plasminogen activator on clot lysis and ventricular dilatation in the treatment of severe intraventricular haemorrhage (1993)
    Springer
    Acta neurochirurgica 122 (1993), S. 32-38 
    Details
    ISSN: 0942-0940
    Keywords: Intraventricular haemorrhage ; tissue plasminogen activator ; fibrinolytic therapy ; ventricular drainage ; hydrocephalus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Twelve patients with severe intraventricular haemorrhage (IVH) underwent intraventricular thrombolysis with recombinant tissue plasminogen activator (rtPA). External ventricular drainage was performed in all patients within 24 hours of haemorrhage. Fibrinolytic therapy was started within 24 hours from the onset of symptoms in ten cases, and in two further cases after 48 hours and 5 days, respectively. Two to 5 mg of rtPA were injected via the ventricular catheter into one or both lateral ventricles. The injection was repeated at intervals ranging from 6 to 24 hours until CT scans demonstrated a substantial reduction of intraventricular blood. The total rtPA doses per patient ranged from 3 to 31 mg. CT scans showed a marked reduction of intraventricular blood and normalization of ventricular size within 24 to 48 hours from the beginning of the flbrinolytic therapy. Rapid reduction of elevated intracranial pressure by continuous diversion of cerebrospinal fluid could be achieved in all patients, because the ventricular catheters never became obstructed by clotted blood during the fibrinolytic therapy. During the period of treatment, the level of consciousness, as classified according to the Glasgow Coma Scale, improved from a mean value of 7 to 12. One fatal case of meningitis most probably due to the ventriculostomy was the only complication related to the treatment. This method of treatment might improve the prognosis in patients in whom a large intraventricular haematoma volume, ventricular dilatation, and impaired cerebrospinal fluid circulation are major determinants for the outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01446983
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  • 9
    Electronic Resource
    Electronic Resource
    Lysis of basal ganglia haematoma with recombinant tissue plasminogen activator (rtPA) after stereotactic aspiration: Initial results (1994)
    Springer
    Acta neurochirurgica 127 (1994), S. 157-160 
    Details
    ISSN: 0942-0940
    Keywords: Intracerebral haematoma ; basal ganglia haematoma ; stereotactic aspiration ; rtPA instillation ; results
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a series of 10 patients with stereotactically treated basal ganglia haematoma rtPA was used to dissolve remaining clots. Pre-operative haematoma volume ranged between 39 and 111 cm3 (average 56 cm3). Stereotactic aspiration alone yielded an average volume reduction of 60% (range 23 to 78%). Haematoma cavity was instillated with rtPA repeatedly beginning 24 hours after the stereotactic intervention. At the end of rtPA therapy between 2 and 4 days after onset of the haemorrhage 67 to 92% (average 84%) of the initial haematoma was removed in all patients. More than 80% of the pre-operative clot could be removed in 8 out of 10 patients between day 2 and 4. There were no signs of rtPA related toxicity. At the end of the follow-up period (between 4 and 17 months-mean 8 months) 6 patients were awake, oriented and with a residual hemiparesis able to live in their familiar environment. It is concluded that local rtPA instillation is an effective additional treatment to further resolution of deep seated intracerebral haematomas after stereotactic aspiration.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01808759
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  • 10
    Electronic Resource
    Electronic Resource
    Ultrasound-guided craniotomy for minimally invasive exposure of cerebral convexity lesions (1994)
    Springer
    Acta neurochirurgica 131 (1994), S. 270-273 
    Details
    ISSN: 0942-0940
    Keywords: Intraoperative ultrasound ; craniotomy ; cerebral convexity ; brain neoplasms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors describe a method of real-time ultrasound-guided craniotomy for an approach to cerebral convexity lesions. During surgery, a specially designed high frequency (7.5 MHz) sector probe with a thin (11 mm), extended tip is used to image the cerebral lesion through a single burr-hole. The distance between burr-hole and lesion and the direction of the target are then determined from the ultrasound images, and craniotomy is completed with the aid of these parameters. Errors in the preoperative planning of the approach, which might result in incorrect placement of the craniotomy, can easily be recognized and corrected at an early stage of the operation, before the craniotomy has been completed. This technique greatly improves the accuracy in placing craniotomy flaps. Since the risk of misplacing the craniotomy is virtually eliminated in lesions which are identifiable on ultrasound images, the technique allows the surgeon to keep the skull opening as limited as possible.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01808626
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