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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 105 (1990), S. 5-13 
    ISSN: 0942-0940
    Keywords: Intraoperative ultrasound imaging ; ultrasound-guided stereotaxy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Intraoperative real-time ultrasound imaging (US) was used in over 500 patients to investigate which of the previously considered applications are of practical use in everyday neurosurgery. During all intraoperative applications for a wide variety of pathological conditions, small deep-seated as well as subcortically located lesions were detected with accuracy; in many instances they could be approached through smaller surgical exposures. US guidance was accurate in 209 cases for the stereotactic introduction of needles or endoscopes into various lesions: thus burrhole evacuation was performed on 148 intracerebral haematomas; in 16 patients endoscopic biopsy and resection of ventricular tumours was performed as well as biopsies of 39 hemispheric brain tumours and aspiration of a brain abscess in 6 instances. Seventy six gliomas were investigated by US imaging; the frequently unclear boundary between tumour and surrounding oedema was not better visualized than with CT or MRI. Moreover, US imaging for the detection of residual tumour towards the end of operation was unreliable. Postoperative imaging through burrholes or other cranial defects was mostly of unacceptably low quality for therapeutic decision making.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 104 (1990), S. 84-95 
    ISSN: 0942-0940
    Keywords: Real time intraoperative ultrasound imaging ; computerized tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Experience with the use of intraoperative ultrasound (US) imaging in over 300 patients are presented in this paper and discussed with special reference to various pathomorphologies as well as their identifiability within the brain/intracranium. In 201 of these patients, the pathomorphological peculiarities in US could be compared with preoperative CT findings. As a general result, all investigated lesions could be identified during intraoperative US investigations with the exception of small aneurysms. Most of the lesions gave at least partly higher echosignals than normal brain tissue, except arachnoid cysts. Size and shape of lesions were comparable in US and CT with the exception of some gliomas; in the latter group, the diffuse image in US was more akin to the situation likely to be found by the surgeon during operation, wheras CT used to give a misleading picture of a more or less clearly delineated tumour. US allowed more accurate differentiation between intratumoural necrosis and cysts than CT: the latter was misleading in many instances. At the present state of development, real time US imaging does not allow a histopathological diagnosis. The ease of handling and the high quality of morphological imaging, however, warrant a number of practical applications in daily neurosurgical practice.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 109 (1991), S. 26-29 
    ISSN: 0942-0940
    Keywords: Fibrin tissue adhesive sealant ; transsphenoidal operation ; CSF fistula ; pituitary tumour
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Fibrin glue (Beriplast, Behring or Tissucol, Immuno) was used for 126 sublabial transseptal transsphenoidal operations in 119 patients from April 1981 to March 1987 in a variety of sellar pathologies together with septal bone and spongycel to seal the sellar floor and the anterior wall of the sphenoid sinus. The incidence of postoperative rhinorrhea was 1.6%. A review of the literature revealed an incidence of 1.5%–9.6% with the use of autologous tissue for sellar packing such as fat or muscle; fibrin glue combined with autologous grafts led to postoperative rhinorrhea in 1%–4.4%. The present results support the view that sellar and sphenoidal sealing with fibrin glue instead of muscle or fat tissue does not raise the incidence of postoperative rhinorrhea.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 108 (1991), S. 134-139 
    ISSN: 0942-0940
    Keywords: Focal cerebral ischaemia ; hydroxyethyl-starch
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a model of focal cerebral ischaemia in the cat (transorbital occlusion of the middle cerebral artery for 60 minutes, thereafter 6 hours reperfusion by clip removal), hydroxyethyl-starch (HAES) (ELOHES; Leopold Pharma GmbH, Graz, Austria) was administered intravenously before and during the ischaemic episode as a 6% or as a 10% solution in a randomised manner (6 animals each group). The size of the developing cerebral infarct was not significantly different when comparing the 6% and the 10% group with the controls (SALINE). Collateral circulation to the infarct border (pial arteries on the suprasylvian gyrus) was also not significantly different between the two groups, except for the first hour of reperfusion, where vessels of the 6% group were wider than vessels of the 10% group. At the infarct border (ectosylvian gyrus) small resistance vessels were significantly more dilated in the 6% than in the 10% group both during the occlusion period and during the reperfusion episode after removal of the clip. Pial arteries dilated less in both HAES-groups than in the controls. It can be assumed, that HAES-incuded decrease of plasma viscosity led to an elevation of blood flow velocity and blood flow quantity (CBF). But the latter might be counteracted by autoregulation of CBF, i.e. vasoconstriction. Thus, a possible positive effect of HAES might in part be counteracted by autoregulation, which explaines that no significant therapeutic effect could be achieved.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Acta neuropathologica 60 (1983), S. 70-74 
    ISSN: 1432-0533
    Keywords: Experimental MCA-occlusion ; Chronic infarction ; rCBF ; Border zone ; Neuronal loss
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The border of a chronic infarct is sharply demarcated. We found in our investigation, however, that this is merely a macroscopic diagnosis and does not say anything about the structure of the tissue and the content of morphologically preserved neurons in the marginal zones. In six cats the left cerebral artery was permanently occluded. Eight weeks later the animals were killed and autoradiographic investigations were conducted on cryostat sections to determine rCBF. Adjacent to every 20-μm section, a 10-μm HE section was prepared. Preserved nerve cells were counted in several areas of the cortex in a symmetric fashion in both the infarcted and the contralateral side in the identical regions where rCBF had been measured in the preceding section. Two additional non-ischemic cat brains served as controls, which were investigated in the same manner as described above. A marked loss of neurons was observed in the border zone of the infarct. Only occasionally preserved ganglion cells were seen in each cortical layer. Even in areas one gyrus distant to the margin of the infact the number of neurons was still reduced by one third as compared to the contralateral side. Starting only with the lateral gyrus the number of ganglionic cells was found to be equal on both sides.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 0942-0940
    Keywords: End to side anastomosis ; flow patterns ; rheological study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Flow property measurements were performed in a plexiglass model of six various types of end-to-side anastomosis (as clinically shown in extracranial to intracranial arterial bypass surgery). Three anastomoses were made without, another three anastomoses with a ringshaped stenosis restricting the lumen to between 25 and 46% of the cross-section as it occurs clinically by formation of thrombi out of the stitching canals. A rectangular type and two 45 degree oblique types—one directed centrally and one directed peripherally—were tested. Pressure head losses at the site of anastomosis were measured under various circumstances of different anastomoses and different flow speeds along the proximal portion of the middle cerebral artery and the superficial temporal artery. Flow resistance values originated by the different types of anastomoses were expressed in terms of additional recipient vessel length. Differences between different types of anastomoses with and without stenosis were very small and under no circumstances exceeded the equivalent of lengthening the recipient vessel by 2 cm. Theoretically, the optimal type of anastomosis is the oblique and centrally directed version; the worst type is the rectangular form. Practically, however, such differences are not relevant. The explanation for such unexpectedly small differences can rheologically be given by considering the dominating role of blood viscosity under the given circumstances, other variables such as short stenosis and angling of flow playing a secondary role.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A total number of 58 parameters (laboratory values, neurological symptoms, and vegetative parameters) were evaluated in 150 patients during the first seven days after severe head injury. The patients were divided into two groups, “survivors” and “non-survivors”. Eight easily evaluable routine parameters with the most significant differences between the two groups of patients were used for statistical evaluation of a “no survival chance score”. These highly indicative parameters are serum osmolarity and urea, blood glucose, total bilirubin, motor reaction to stimuli, body temperature, respiratory activity, and pupil reaction. A “low survival chance limit” was evaluated from each of these parameters by computer analysis. None of the patients in the series survived when three or more of these eight parameters had climbed beyond the limit. So far, the system is able to predict “no survival chances” in 50.8% of the non-survivors some six days prior to death; 80% of these predictions could be made by the fourth day after injury.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 69 (1983), S. 273-281 
    ISSN: 0942-0940
    Keywords: Acute aneurysm surgery ; prevention of symptomatic vasospasm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A treatment protocol for a controlled open study in patients with subarachnoid haemorrhage (SAH) from cerebral aneurysms is presented, applying acute surgery and pharmacological prevention of symptomatic vasospasm: In patients clinically graded I–III (Hunt and Hess), operation is performed within 48 to 72 hours. After aneurysm clipping, the calcium-antagonist Nimodipine is administered 1. topically during operation, 2. intravenously until day 14 after SAH, 3. perorally until day 21 after SAH. Preliminary results in the first 31 patients show no management mortality and no severe management morbidity. Severe symptomatic vasospasm has never occurred. At 3 months follow-up investigation in 27 of the 31 patients, 5 had minimal neurological deficit; all patients are fully resocialized, working in their previous professions.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 74 (1985), S. 124-128 
    ISSN: 0942-0940
    Keywords: Intracerebral haemorrhage ; endoscopic evacuation ; Laser ; ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A new combination of technologies has been used for the evacuation of intracerebral haemorrhages: The aim is 1. minimal trauma to cerebral tissue in the surgical approach, 2. atraumatic rather than complete removal of blood clots, 3. better prevention of rebleeding. Via a 1 cm burrhole, a 6 mm Ø endoscope is introduced and connected to a video display. Using a suction-irrigation system in the endoscope, fluid turbulence and rhythmic pressure variation in the haematoma cavity at 10–15 mm Hg allow the evacuation of the haematoma under visual control. Bleeding vessels can be coagulated using a 1.5 mm Ø Neodym YAG Laser Microtube. If a small craniotomy is performed instead of only a burrhole, facilities for intraoperative ultrasonic display of the haematoma provide additional control thereby enhancing precision and protection of cerebral tissue on approaching the haematoma and during its evacuation.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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