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  • 1
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 0942-0940
    Keywords: Keywords: Acoustic neuroma; cranial nerve preservation; Gamma Knife; stereotactic radiosurgery; vestibular schwannoma.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ From April 1992 till December 1998 stereotactic radiosurgery (Gamma Knife) was applied to 192 patients with vestibular schwannomas. 56 of them had radiosurgery as primary treatment modality and were followed-up for at least 4 years (48–80 months, median 62).  Without fatal complications, control of tumour growth was achieved in all but three cases, useful hearing being preserved in more than one half of the patients (62%). The neurological state improved in 30 patients (54%). Irradiation-associated adverse effects (18%) comprised neurological signs (incomplete facial palsy, four cases (two recovered completely), and mild trigeminal neuropathy, three cases, respectively) and morphological changes (three patients) marked by an enlargement of pre-existing cystic components calling for additional surgical treatment: Microsurgical decompression was performed in two cases, the third patient underwent a shunting procedure because of hydrocephalus formation.  Based on the present data, radiosurgery represents an effective treatment for vestibular schwannomas associated with an exceptionally low mortality rate and a good quality of life. With respect to the preservation of cranial nerve function, results are comparable to microsurgical resection. A short duration of hospitalization and a quick return to normal activities constitute further advantages and contribute to cost effectiveness in public health care.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 141 (1999), S. 811-818 
    ISSN: 0942-0940
    Keywords: Keywords: Gamma knife; stereotactic radiosurgery; glomus jugulare tumour; paragangliomas.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  The aim of this clinical study was to determine the tumour control rate, clinical outcome and complication rate following gamma knife treatment for glomus jugulare tumours. Between May 1992 and May 1998, 13 patients with glomus tumours underwent stereotactic radiosurgical treatment in our department. The age of these patients ranged from 21 to 80 years. The male : female ratio was 2 : 11. Six patients had primary open surgery for partial removal or recurrent growth and subsequent radiosurgical therapy. Radiosurgery was performed as primary treatment in 7 cases. The median tumour volume was 6,4 cm3 (range: 4,6–13,7 cm3). The median marginal dose applied to an average isodose volume of 50% (30–50%) was 13,5 Gy (12–20 Gy). In 10 patients, a total of 48 MRI and CT follow-up scans were available. The remaining three patients have been excluded from the postradiosurgical evaluation since the observation time (t〈12 months) was too short or patients were lost to follow up. The median interval from Gamma Knife treatment to the last radiological follow-up was 37,6 months (5–68 months). In 4 patients (40%) decreased tumour volumes were observed and in 6 cases (60%) the tumour size remained unchanged. Neurological follow-up examinations revealed improved clinical status in 5 patients (50%), a stable neurological status in 5 patients (50%) and no complications occurred. According to our preliminary experience Gamma Knife radiosurgery represents an effective treatment option for glomus jugulare tumours.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 116 (1992), S. 128-136 
    ISSN: 0942-0940
    Keywords: Brain tumour ; lateral ventricle ; topography ; microsurgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Tumours of the lateral ventricle in most cases enlarge significantly before signs and symptoms are exhibited. In the years between 1980 and 1991 we encountered 55 patients of all age groups with tumours of the lateral ventricle. All were diagnosed either by CT or MRI, and in lesions with good enhancement on CT additional angiography was performed. All 55 tumours were operated upon using microsurgical techniques. The approach was chosen according to the location of the tumour, preferably transcortical. In selected cases large tumours were removed in a twostage operation. Only in one frontal horn and Cella media tumour an interhemispheric transcallosal approach was used. Postoperative or surgically related mortality was experienced in 3 cases. Life expectancy and morbidity were dependent upon histology.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 0942-0940
    Keywords: Bovine dowel ; cervical discectomy ; interbody fusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Anterior cervical discectomy and vertebral interbody fusion is a widely used technique in the treatment of radicular or cord compression. Instead of using autologous bone removed from the iliac crest, a heterologous bovine dowel was used for fusion. Sixty-six patients presenting with radicular pain or myelopathy were entered into the study retrospectively. Medial herniated, soft or calcified disc, osteophytes with and without herniated disc material, and bony stenosis at one or two levels were shown by CT or MRI studies. Postoperatively, 88% of the patients noted relief of pain and motor improvement. Most of the patients' sensory deficits and myelopathy improved within 6–12 months. No complications occurred and only one re-operation had to be performed at the same level. In the follow-up period between 1–4 years, no cases of instability after surgery were reported. Operating time and postoperative pain were reduced because bone harvest from the iliac crest was not necessary. In postoperatively performed CT and MRI, the bovine dowel was surrounded by a “halo”-like structure and the specific structure of the bovine implant was still present. No real bony fusion occurred, but clinical stability was equivalent to autologous bone fusion reported in the literature. However, there was no MRI evidence of “living bone tissue” within the bovine dowel. This finding is in contrast to the current belief that the bovine implant is replaced or infiltrated by bony growth.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 140 (1998), S. 1101-1111 
    ISSN: 0942-0940
    Keywords: Keywords: Radiosurgery; Gamma knife; Linac; cost effectiveness.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  Radiosurgical treatment can be carried out by means of a Gamma Knife or a Linear Accelerator. The Linear Accelerator may be either a single-purpose appliance, exclusively employed in radiosurgery, or an adapted appliance, which is used primarily for fractioned radio-therapy, and only additionally for radiosurgical purposes. The first alternative will be referred to briefly as a “dedicated Linac”, the latter as an “adapted Linac”.  Cost accounting data for these alternatives will be discussed under three main categories: investment costs, operating costs, and finally staffing costs. Costs are only considered to the extent that this is necessary to facilitate a comprehensive cost comparison. Factors for which the costs remain the same or at least broadly the same will from the outset not be taken into consideration. These include, for instance, the costs of general or special administration, diagnosis, and image processing. The results and conclusions of this study therefore cannot be employed immediately in the evaluation of cost reimbursement schemes of the type carried out by agencies responsible for social insurance. Here, appropriate complete cost analyses especially for this purpose are required.  The final comprehensive cost comparison reveals that the adapted Linac is the most favourable alternative with small annual quantities of patients. With larger numbers of patients the Gamma Knife represents the most favourable from a cost accounting angle. The dedicated Linac accordingly does not have a cost advantage for any of the examined numbers of patients. Clearly the lowest treatment costs per patient can be achieved by employing a Gamma Knife and using it to capacity.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 0942-0940
    Keywords: Keywords: Radiosurgery; gamma knife; glomus jugulare tumour.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ Leksell Gamma Knife was used to treat 66 patients with glomus jugulare tumour at 6 European sites between 1992–1998. The age of the patients ranged between 18–80 years (median 54 years). Gamma Knife radiosurgery was a primary treatment in 30 patients (45.5%). Open surgery preceded radiosurgery in 24 patients (36.4%), embolisation in 14 patients (21.2%) and fractionated radiotherapy in 5 patients (7.6%). The volume of the tumour ranged 0.5–27 cm3 (median 5,7 cm3). The minimal dose to the tumour margin ranged between 10–30 Gy (median 16.5 Gy).  After radiosurgery 52 patients were followed, the follow up period was 3–70 months (median 24 months). Neurological deficit improved in 15 patients (29%) and deteriorated in 3 patients (5,8%), one transient and two persistant. Neuroradiological follow up using MRI or CT was performed in 47 patients 4–70 months (median 24 months) after radiosurgery. Tumour size decreased in 19 patients (40%) while in the remaining 28 patients (60%) no change in the tumour volume was observed. None of the tumours increased in volume during the observation period. Control angiography was performed in 6 patients. Pathological vascularisation completely disappeared in one patient, reduced in two and there was no change in the remaining three.  Radiosurgery proves to be a safe treatment for glomus jugulare tumour with no mortality and no acute morbidity. Because of its naturally slow growth rate, up to 10 years of follow up will be necessary to establish a cure rate after radiosurgery for these lesions.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 0942-0940
    Keywords: Radiosurgery ; cobalt-60 Gamma-unit ; results
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary During the period of one year, from the 21. 4. 1992 to 21. 4. 1993, a total of 201 radiosurgical sessions on 181 patients were performed with the first Austrian Gamma-unit in Graz. 42% of radiosurgical sessions were undertaken for malignomas, 20% for meningiomas, 11.5% for vascular malformations, 9% for neurinomas, 8.5% for low grade astrocytomas and glomus jugulare tumours, 5% for sellar and suprasellar lesions, and 4% for functional disorders. Dose plan data for all the lesions treated are shown. Clinical and imaging data of the first year which are available for 120 patients (66%) are presented and discussed.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 139 (1997), S. 923-927 
    ISSN: 0942-0940
    Keywords: Basilar artery ; fenestration ; subarachnoid hemorrhage ; cerebral aneurysm ; microsurgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A case of a ruptured saccular aneurysm arising from the proximal portion of a partially duplicated basilar artery in a 36-year-old woman is reported. CT and lumbar puncture confirmed subarachnoid haemorrhage. Cerebral angiography detected a vertebrobasilar junction aneurysm associated with basilar artery fenestration. The patient underwent successful clipping and coating of the aneurysm by a right lateral suboccipital osteoclastic approach. Embryological development, pathogenesis, diagnostic and therapeutic difficulties of this vascular malformation are discussed in this report.
    Type of Medium: Electronic Resource
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