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  • 1
    ISSN: 0942-0940
    Keywords: Keywords: Delayed facial palsy; herpes simplex virus; magnetic resonance image; vestibular schwannoma.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  A patient developed delayed facial nerve palsy at the level of House-Brackmann grade I to grade III 10 days after vestibular schwannoma surgery by the suboccipital transmeatal approach. The palsy had completely recovered after one month. Immunological study showed reactivation of herpes simplex and magnetic resonance (MR) imaging demonstrated an abnormal enhancement pattern of the facial nerve; intense enhancement of the distal intracanalicular segment and labyrinthine segment, similar to the MR findings for Bell's palsy. A prospective control study on the enhancement pattern of the functionally preserved facial nerve after vestibular schwannoma surgery in six cases showed a similar pattern to that of the normal facial nerve. Based on these findings, we propose the hypothesis that herpes simplex reactivation is an underlying cause of delayed facial palsy after vestibular schwannoma surgery.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 142 (2000), S. 33-37 
    ISSN: 0942-0940
    Keywords: Keywords: Carotid cave; intracranial aneurysms; surgical approach; contralateral approach.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ Background. To evaluate the surgical approach and clipping of aneurysms located at the carotid cave region.  Method. Between 1980 and 1998 we have adopted the well known ipsilateral approach for exposure and securing of carotid cave aneurysms. In four patients, we had the opportunity to use a contralateral approach to carotid cave aneurysms, with easier dissection and application of a simple aneurysmal clip. The visual acuity of the patients did not deteriorate from the pre-operative level.  Finding and Interpretation. Aneurysms located at the carotid cave region may be approached easily and safely through a contralateral craniotomy with application of the aneurysm clip from an angle medial and inferior to the optic nerve.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 141 (1999), S. 341-347 
    ISSN: 0942-0940
    Keywords: Keywords: Spinal cord neoplasm; ependymoma; intramedullary tumour; surgery.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  Surgical outcome of intramedullary spinal cord ependymoma was investigated in order to define the treatment strategy. We have operated on 18 cases of intramedullary spinal cord ependymoma based on the principle of radical resection. The follow-up periods ranged from 10 months to 249 months with an average of 86.2 months. Postoperative neurological status in the long follow-up periods was compared to the pre-operative status and was correlated with the histological grade of malignancy. Total removal of the tumour was achieved in 17 cases, and subtotal removal followed by radiation therapy was conducted in 1 case. There was neither surgical mortality nor radiological evidence of recurrence in the long-term follow-up periods. The final outcome of the neurological condition was improved in 1 case, unchanged in 15 cases (including a case of subtotal removal) and deteriorated in 2 cases. The deterioration was in the form of gait disturbance due to the worsening of proprioception in 2 cases and dysaethesia in 1 case. Histological examination showed no evidence of anaplasia in 6 cases, evidence of early anaplasia in 10 cases, and moderate evidence of anaplasia in 2 cases. No relationship between the histological malignancy and clinical course was found. Intramedullary spinal cord ependymoma should be removed radically as early as possible while taking great care to avoid posterior column injury. Histologically malignant ependymoma might be a clinical exception.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 106 (1990), S. 127-131 
    ISSN: 0942-0940
    Keywords: Aneurysm ; grade 5 ; outcome ; subarachnoid haemorrhage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The purpose of the present study was to describe the clinical course of patients with Grade-5 ruptured aneurysms (WFNS grading). Among 250 consecutive cases of ruptured aneurysms, 60 Grade-5 patients were reviewed retrospectively, consisting of 24 males and 36 females with an average age of 58 years. Thirty-two patients were directly transferred to our clinic, while the remaining 28 were referred from other clinics. Duration from rupture to arrival at our clinic was within 1 hour in 25 cases and within 2 hours in 43 cases. Systolic blood pressure on admission was 186 mmHg on average. Obvious misdiagnoses by primary physicians were made in 7 cases. Ventricular drainage and clipping/trapping of the aneurysms were performed in 7 and 25 cases, respectively. Forty-nine patients died and the remaining 11 survived. One made a good recovery, 1 was moderately disabled, 8 severely disabled, and 1 in a vegetative state. The prognosis for Grade-5 patients is well known as being extremely poor, which also was the case in our series. Early referral and early surgical intervention have not changed this poor prognosis. Possible improvement of the outcome of this group might be expected by 1) public health and primary physician education on aneurysmal subarachnoid haemorrhage, and 2) control of blood pressure during referral.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 139 (1997), S. 1055-1060 
    ISSN: 0942-0940
    Keywords: Neurofibromatosis type 1 ; intramedullary spinal cord tumour ; astrocytoma ; pathology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We investigated the characteristic features of intramedullary spinal cord tumour associated with neurofibromatosis type 1 (NF-1). We have experienced 44 cases of pathologically confirmed intramedullary spinal cord tumour. Diagnosis of NF-1 was done according to the criteria set by the National Institute of Health Consensus Development Conference. Within the described population NF-1 was diagnosed in two patients. Both the patients were male and histopathologically the tumours were anaplastic astrocytoma and glioblastoma multiforme respectively. 6 cases of NF-1 associated with intramedullary spinal cord tumour based on the above diagnostic criteria have so far been reported, including our 2 cases. Of these 6 cases, 5 were male and in one sex was not described. The tumour was an astrocytoma in all 6 cases. This finding suggested that intramedullary spinal cord tumour associated with NF-1 tends to occur predominantly in males and that histopathologically the tumour is likely to be an astrocytoma. We conclude that the criteria proposed by the National Institute of Health Consensus Development Conference are contributory in making an accurate pre-operative pathological diagnosis of intramedullary spinal cord tumour associated with NF-1.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 0942-0940
    Keywords: Keywords: Syringomyelia; Chiari malformation; posterior cranial fossa; major cistern.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  In order to treat syringomyelia associated with adult type Chiari malformation, the authors developed a method of expansive suboccipital cranioplasty (ESC) that involves enlarging the small posterior fossa to obtain a sufficient flow of cerebrospinal fluid (CSF). The relative effectiveness of ESC with the obex plugged and not plugged was also examined, as well as other factors influencing the operative results.  Twenty patients without arachnoid adhesion at the major cistern underwent ESC without opening the arachnoid membrane at the major cistern. After surgery, all improved with no recurrence and CSF flow study using magnetic resonance (MR) imaging showed significant improvement of the flow at the major cistern. Another 20 patients without arachnoid adhesion also underwent ESC but with obex plugging. Sixteen improved and one displayed only temporary improvement with recurrent syringomyelia due to postoperative arachnoid adhesions. The remaining three showed no change in spite of shrinkage of the syrinx on postoperative MR imaging. These three patients had displayed pre-operative symptoms over an approximately 10-year period involving almost the entire axial plain of the spinal cord, and presented a large syrinx before surgery. In 4 patients with arachnoid adhesions, all required intra-arachnoid procedures in addition to ESC.  Intra-arachnoid procedures are not necessary to facilitate restoration of CSF flow in patients without arachnoid adhesions, because ESC can release the CSF flow blockage in the major cistern even without plugging of the obex. An associated arachnoid adhesion at the major cistern or a long-standing syringomyelia with irreversible damage of the spinal cord results in a poor operative prognosis. When posterior fossa surgery fails, insufficient decompression or postoperative arachnoid adhesions at the major cistern as the cause of treatment's failure should be evaluated by CSF flow studies using phase contrast MR imaging.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0942-0940
    Keywords: Brainstem haemorrhage ; CT scan ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Thirty-two patients with CT-documented primary brainstem haemorrhage were reviewed retrospectively to obtain a clearer overall clinical picture, especially of the severely disabled survivors. They were divided into 3 groups according to outcome: eleven cases (Group 1) died within 1 month following haemorrhage, 11 cases (Group 2) survived but became bedridden, necessitating full living support, and 10 cases (Group 3) showed minimal neurological deficits and resumed normal activities. Owing to CT and improved critical care, the survival rate was 66% for the whole series. Group 2 comprised 34% of all cases. These patients were mostly alert, quadruplegic, and communicated only with great difficulty. The most common initial symptoms and CT finding in each group were as follows;Group 1: unconsciousness, respiratory disturbance, negative light reflex, tachycardia, and haematoma 〉3.0 cm;Group 2: disturbance of consciousness, respiratory disturbance, positive light reflex, normal heart rate, and 2.0〉 haematoma 〈3.5 cm; andGroup 3: alertness or only slight disturbance of consciousness, normal respiration, positive light reflex, normal heart rate, haematoma 〈2.5 cm. Although there is an overlap among them, these findings will be useful to distinguish the three groups from each other. Patients with disturbance of consciousness, respiratory disturbance, positive light reflex, normal heart rate, and 2.0〉 haematoma 〈3.5 cm, have a chance to survive, but in severely disabled condition, if they were treated with vigorous intensive care in the acute stage.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 25 (1983), S. 217-223 
    ISSN: 1432-1920
    Keywords: Cranium bifidum ; encephalocoele ; meningocoele
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Six cases of congenital subscalp nodule associated with underlying cranium bifidum are reported. A plain skull roentgenogram showed a midline bone defect in the parieto-occipital region near the lambda. CT scan demonstrated neither brain malformation nor ventricular deformity except for the high position of the straight sinus. Cerebral angiography revealed an elongation of the vein of Galen and anomalous upward course of the straight sinus. At surgery, the tumor was solid and connected to a cord which extended intracranially via the cranium bifidum and blended with thickened arachnoid membrane either on the dorsal aspect of the midbrain or at the surface of the anterior vermis. Histologically, the tumor consisted in all cases of arachnoid cells and fibrous tissue with immature glial cells in one case. Possible pathogenesis of these tumors could be a result of the fetal nuchal bleb.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1432-1920
    Keywords: Key words Pituitary ; Adenohypophysitis ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report the skull radiograph, CT and MRI findings in three patients with lymphocytic adenohypophysitis mimicking pituitary adenoma. All cases were associated with pregnancy. CT demonstrated a pituitary mass but did not differentiate lymphocytic adenohypophysitis from pituitary adenoma. The skull radiographs showed either a normal sella turcica or minimal abnormalities; they did not show ballooning or destruction. The MRI appearances were distinctive: relatively low signal on T1-weighted images; preservation of the bright posterior pituitary lobe despite the presence of a relatively large pituitary mass, less common in macroadenomas; marked contrast enhancement compared with pituitary macroadenomas; and dural enhancement adjacent to a pituitary mass.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-1920
    Keywords: Chordoma ; MRI ; Ecchordosis physaliphora
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Chordomas are rare neoplasms arising from notochordal remnants found predominantly in the clivus and the sacrococcygeal regions. Most clivus chordomas show extradural extension and bone destruction. Such a tumour can rarely be intradural. This report is concerned with the radiological findings in prepontine intradural chordoma.
    Type of Medium: Electronic Resource
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