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  • 1
    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
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  • 2
    ISSN: 0942-0940
    Keywords: Keywords: Accuracy central sulcus; cortical mapping; frameless neuronavigation; image guided surgery.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  Background. The purpose of this prospective study was to localize the central sulcus by frameless neuronavigation and to project this anatomical structure to the outside of the skull on the skin. This method was analyzed in respect to its practicability, accuracy, and potential applications.  Method. In 27 patients investigated (28 unaffected hemispheres), the central sulcus was virtually projected to the outside of the skull using frameless neuronavigation and a virtual pointer elongation of 15 or 20 mm. The following parameters were measured on the scalp: 1. the distance between the bregma and the midline junction of the central sulcus, and 2. the angle between the central sulcus and the midline. These dada were compared with measurements based on the original axial MR images of these patients. Finally, a laboratory phantom study was designed in analogy to a patient's examination for estimation of the overall accuracy of the neuronavigation system in the experimental setup used in this study.  Findings. Virtual pointer projection of the central sulcus to the outside of the skull using frameless neuronavigation was found to be easily possible. The distance between the bregma and the midline junction of the central sulcus amounted to a mean of 55 mm on the left and 56 mm on the right. The angle between the central sulcus and the midline reached a mean of 63° on the left and 60° on the right. These data confirmed results of other studies with no frameless neuronavigation devices. The phantom study revealed a mean overall inaccuracy of 0.9 mm at a virtual pointer elongation of 15 mm. At a virtual pointer elongation of 20 mm, the mean overall inaccuracy of our study was 1.1 mm. These results correspond to the inaccuracy of frame based stereotaxy.  Interpretation. It is easily possible, valid, and reliable to virtually project the central sulcus to the outside of the skull with an acceptably low inaccuracy using frameless neuronavigation. This is important for research studies that correlate and integrate different functional imaging methods with the aid of frameless neuronavigation.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 134 (1995), S. 200-206 
    ISSN: 0942-0940
    Keywords: Cavernous angioma ; spinal cord ; microsurgery ; vascular malformation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Nine consecutive cases of surgically treated spinal cavernous angiomas are presented. Our series consists of 6 men and 3 women with the following intramedullary spinal location of the cavernomas: 4 cervical, 4 thoracic and 1 thoraco-lumbar. All 9 patients were symptomatic with signs of myelopathy and senorimotor deficits corresponding to the level of the lesion. Six patients underwent laminectomy and in three patients a hemilaminectomy was performed to approach the lesion. A complete resection of the cavernoma was achieved in each case. Five patients showed transient neurological deterioration, in three cases the neurological status remained unchanged, and one patient experienced a slight improvement of symptoms during the early postoperative period. At followup examination (mean 14 months postoperative), a clear improvement of the clinical signs was demonstrable in 6 patients, and a complete resolution of the pre-existing symptoms and signs was achieved in two individuals. In one case the clinical state remained unchanged. It is concluded that microsurgical resection is the treatment of choice in cavernomas of the spinal cord.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 0942-0940
    Keywords: Spinal stenosis ; lumbar spine ; surgical treatment ; operative approach ; anatomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A unilateral laminotomy for bilateral access to the lumbar spinal canal was investigated in human cadaver spine specimens to test its practicability in the treatment of spinal stenosis. Microsurgical decompression was performed by partial resection of the ipsilateral facet, the medial portion of the laminar arch, the contralateral facet and by complete removal of the ligamentum flavum. Anatomical, radiological and morphometrical studies on 4 adult cadaver spine specimens have proved the feasibility of this unilateral approach. Complete bilateral flavectomy and partial bilateral facetectomy were the essential surgical steps for an adequate operative decompression.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 0942-0940
    Keywords: Keywords: fMRI; motor cortex; pre-operative planning; image-guided intervention
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Purpose: This paper describes the potentials of functional magnetic resonance imaging (fMRI) to map sensory motor cortex in patients with mass lesions near primary motor cortex and to guide neurosurgical procedures located close to eloquent brain regions. Material and Methods: 7 patients with mass lesions near the central sulcus and 10 healthy volunteers were studied using a blood oxygenation level dependent 2D multislice multishot T2* weighted gradient echo EPI sequence on a 1.5T Phillips Gyroscan during alternating epochs of rest and motor activation of hand, foot and tongue. Sites of neuronal activation were identified by statistical analysis of the signal time course using Kolmogorov Smirnov statistics. Results: Neuronal activation following motor tasks consistently localised to the contralateral precentral gyrus and the supplementary motor area, even in the presence of local brain pathology. Additionally we could observe activation in primary sensory areas (postcentral gyrus) and supplementary motor area (SMA) in some cases. Conclusion: fMRI is capable of mapping sensory motor cortex even in the presence of distorting brain lesions. Since this information will provide valuable information to the neurosurgeon during pre-operative planning, we consider this method for neurosurgical navigation a valuable tool in the routine diagnostic of intracerebral interventions.
    Type of Medium: Electronic Resource
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  • 6
    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
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  • 7
    ISSN: 0942-0940
    Keywords: Spinal stenosis ; lumbar spine ; neurogenic claudication ; spinal instability ; surgical treatment ; low back pain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The surgical aim in the treatment of symptomatic lumbar spinal stenosis is the relief of the patient's complaints by an adequate neural decompression. Unilateral laminotomy and bilateral spinal canal decompression represents such a safe, effective and minimally invasive surgical method. This technique has been successfully used in the operative treatment of 29 patients with symptomatic mono- or multisegmental lumbar stenosis. There was no surgically induced neurological deterioration. In one patient, an inadvertent dural tear occurred, and due to unchanged symptoms another patient with a multisegmental stenosis had to be re-operated on at an additional level. Postoperatively, 25 of the 27 patients with neurogenic claudication (93%) demonstrated a marked improvement of the walking distance. The follow-up of 25 patients (mean follow-up time was 18 months) demonstrated an excellent result without pain in 7 patients (28%); a good outcome with mild residual pain, but a normal working capacity in 15 patients (60%); and a fair outcome with unchanged postoperative low-back pain but markedly improved working capacity and walking distance in 3 patients (12%). Postoperative morphometric evaluation as well as the clinical improvement of the patient's symptoms clearly demonstrated that bilateral ligamentectomy and recess decompression were adequately and successfully achieved via unilateral approach.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-1084
    Keywords: Suprasellar masses ; MRI ; CT ; Contrast media ; Differential diagnosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This review demonstrates the features of truly suprasellar masses in modern imaging based on the clinical, CT, and MRI findings of 42 patients with suprasellar masses in correlation to the histologic findings. The radiologic examinations were evaluated retrospectively to determine if diagnosis can be made based on specific imaging patterns. The most frequent clinical findings of space-occupying suprasellar masses were visual disturbances, diabetes insipidus, and symptoms and signs of occlusive hydrocephalus. There were no clinical features specific for any of the observed masses. Craniopharyngiomas were the most frequent tumors. They appeared in two different forms, as cystic and as solid enhancing masses. The cystic tumors could not be differentiated from cystic hamartomas or cystic gliomas by CT or MRI. The solid craniopharyngiomas were similar to meningiomas and hamartomas. In craniopharyngiomas of adults calcifications were not common. In CT and especially in MRI gliomas were characterized by the diffuse infiltration of the adjacent brain tissue or optic nerve. Except for meningiomas, all lesions were highly variable in appearance, making a reliable characterization by CT and MRI difficult in many cases. However, administration of contrast media in some cases resulted in a better tumor delineation. Compared with unenhanced MRI the enhanced scans did not increase diagnostic efficacy for neoplasms, but were helpful in the differentiation from inflammatory diseases. The MRI technique was superior to CT in demonstrating the anatomic relationships, thus facilitating evaluation of origin and extent of the lesions. The CT technique, of course, was more reliable in the detection of calcifications. Both CT and MRI are not tissue-specific, however,and suprasellar tumors as well as many other neoplasms cannot be classified using only one of these imaging techniques.To optimize the diagnostic strategy both imaging modalities should be used with close regard to patient history, physical examination, and clinical parameters.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Der Unfallchirurg 99 (1996), S. 905-908 
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Lumbale Luxationsfraktur ; Paraplegie ; Key words Lumbar luxation fracture ; Paraplegia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: This report details a traumatic spinal column lesion due to a lap seat belt. A healthy 22-year-old woman was involved in a car accident and suffered a lumbar luxation fracture at the level L 1 – L 2. She developed acute transsectional symptoms with paraplegia and severe hyperpathia in her legs. Plain radiographs (antero-posterior and lateral projection) and lumbar CT scans demonstrated an instabile flexion-distraction fracture with ventral compression of the vertebral body of L 2 and ventrolisthesis of L 1 over L 2. Surgical reposition of the luxation fracture and removal of a spinal epidural hematoma was performed 4 h after the trauma. Stabilization was achived by monosegmental dorsal transpedicular spondylodesis with a fixateur interne. In follow-up the neurological deficits markedly improved. Six months after the trauma, the patient is able to walk, has no paresis and no genitourinary disturbances; only mild dysesthesia remains. This posttraumatic course confirms that spinal traumas below L 1 which spare the conus have a favorable prognosis, because the peripheral nerves of the cauda equina are able to recover. This injured patient was the only one using a lap seat belt; the other four passengers in the same compact car – wearing lap and diagonal seat belts – suffered no harm. We conclude that lap seat belts are not acceptable as an adequate security standard in modern automobile technology.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1433-0350
    Keywords: Key words Odontoid fracture ; Synchondrosis ; Spinal cord injury ; Cervical spine ; Pediatric spine ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A case of traumatic synchondrotic disruption in a 15-month-old girl is reported; she was treated with interlaminar wiring of C1–C2 without grafting. Reduction of the dislocation and angulation and stability were achieved without evidence of growth disturbance. However, the child's initial poor neurological status with tetraplegia below the level of C7 remained unchanged. Besides our case, there are only three other cases in the literature of young children primarily operated on for a traumatic odontoid synchondrotic disruption. Even though the dorsal interlaminar wiring of C1–C2 without grafting is an easy and safe procedure even in the very young, the optimal form of treat-ment for this rare injury is still unsettled.
    Type of Medium: Electronic Resource
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