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  • 1
    Electronic Resource
    Electronic Resource
    Noninvasive differentiation of meningiomas from other brain tumours using combined111indium-octreotide/99mtechnetium-DTPA brain scintigraphy (1996)
    Springer
    Acta neurochirurgica 138 (1996), S. 1179-1185 
    Details
    ISSN: 0942-0940
    Keywords: [111In-DTPA-D-Phel]-octreotide ; somatostatin receptors ; meningioma ; brain tumour
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have studied prospectively 47 patients with CNS tumours including 16 meningiomas and 33 other tumours using combined111In-octreotide and99mTc-DTPA brain scintigraphy.111In-octreotide scintigraphy was used to image somatostatin receptors (SSR) and99mTc-DTPA scintigraphy was used to assess the integrity of the blood-brain barrier (BBB). A total of 32 tumours (65%) were detected. All SSR positive tumours also had positive99mTc-DTPA scans and all SSR negative tumours were negative on99mTc-DTPA scans. Among the tumours located outside the BBB, all meningiomas and two out of six schwannomas were positive on combined SSR/99mTc-DTPA scintigraphy. Among the tumours located inside the BBB, seven out of nine gliomas grade I–III were negatitve, whereas all glioblastomas were positive. Other positive tumours included one malignant non-Hodgkin lymphoma and two cerebral metastases. SSR scintigraphy alone was non-specific in the diagnosis of meningiomas, as 16 non-meningiomatous tumours also had positive SSR scans probably due to a breakdown of the BBB (excluding the malignant lymphoma). Measuring the tumour-to-background ratio on SSR scans improved specificity, but sensitivity was decreased below 70% because some meningiomas were only slightly positive. Only the ratio of SSR scintigraphy to conventional99mTc-DTPA brain scintigraphy (SSR-to-BS index) allowed a reliable differentiation of meningiomas from other CNS tumours, most notably from schwannomas (sensitivity: 94%; specificity: 100%). Our results support the usefulness of combined SSR and conventional brain scintigraphy in the noninvasive pre-operative diagnosis of meningiomas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01809748
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  • 2
    Electronic Resource
    Electronic Resource
    Evaluation of hemodynamic responses in head injury patients with transcranial doppler monitoring (1997)
    Springer
    Acta neurochirurgica 139 (1997), S. 804-817 
    Details
    ISSN: 0942-0940
    Keywords: Transcranial Doppler ultrasound ; head injury ; autoregulation ; A-waves
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Transcranial Doppler (TCD) can monitor middle cerebral artery (MCA) velocity which can be recorded simultaneously with other physiologic parameters such as end tidal (Et) CO2, arterial blood pressure and intracranial pressure (ICP), in head injured patients. Relative changes in MCA velocity can be used to reflect relative MCA blood flow changes during ICP waves, and also to evaluate cerebral autoregulation, CO2 reactivity and hemodynamic responses to mannitol and barbiturates. The utility and practicality of short intervals of TCD monitoring to evaluate hemodynamic resposnes, was evaluated in a group of 22 head injured patients (average Glasgow coma score 6). During ICP A waves, MCA velocity always decreased during the peak of the wave, and during ICP B waves, fluctuated synchronously with the ICP. Dynamic cerebral autoregulation, and reactivity to CO2, were reduced within 48 hours of admission. Impaired cerebral autoregulation within 48 hours of admission did not correlate with outcome at 1 month. Mannitol infusion caused an increase in MCA velocity (15.4 ± 7.9%) which was significantly correlated to the impairment of dynamic autoregulation (r=0.54, p 〈 0.0001). The MCA velocity response to a test dose of barbiturates was significantly correlated to the ICP (r=0.61, p 〈 0.01) response as well as to the CO2 reactivity (r=0.37, p 〈 0.05). Continuous MCA velocity monitoring using TCD may be useful in evaluating a variety of hemodynamic responses in head injury patients and may replace more cumbersome cerebral blood flow techniques which have been used in the past for these purposes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01411398
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  • 3
    Electronic Resource
    Electronic Resource
    Supratentorial haemangioblastoma (1978)
    Springer
    Acta neurochirurgica 44 (1978), S. 173-177 
    Details
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A case of supratentorial haemangioblastoma is presented. Diagnostic examinations, including computerized axial tomography, were not accurate. Histological examination of the removed tissue disclosed the correct diagnosis. Supratentorial haemangioblastomas are very rare tumours. We describe a case with regard to preoperative neuroradiological investigations, computerized axial tomography, and final histological diagnosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01402059
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  • 4
    Electronic Resource
    Electronic Resource
    Evaluation of the calcium-antagonist nimodipine for the prevention of vasospasm after aneurysmal subarachnoid haemorrhage (1987)
    Springer
    Acta neurochirurgica 85 (1987), S. 7-16 
    Details
    ISSN: 0942-0940
    Keywords: Subarachnoid haemorrhage ; vasospasm ; intracranial blood flow ; ultrasound ; nimodipine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 70 consecutive patients admitted within four days after the first aneurysmal subarachnoid haemorrhage (SAH) were evaluated by daily transcranial Doppler ultrasound (TCD) measurement of the blood flow velocities (BFVs) of both middle cerebral arteries (MCAs) and by daily recordings of their clinical grade (Hunt and Hess). Patients with no or only little subarachnoid blood in the first CT after admission were classified as low-risk for the development of symptomatic vasospasm (VSP), and patients with big subarachnoid clots or thick layers of subarachnoid blood were graded as high-risk patients for symptomatic VSP. The first series of 33 patients received no nimodipine whereas the second series of 37 patients were treated with nimodipine 2 mg/h intravenously, starting within 24 hours after the SAH in the majority of patients. 7–14 days postoperatively, the intravenous dose was changed to oral nimodipine 60 mg/q4h for one week and then discontinued. A mean BFV curve of the side with the higher flow velocities correlated with the mean clinical status (Hunt and Hess) was calculated by computer analysis for the patients treated without nimodipine and for those receiving nimodipine in each risk group. The mean BFV curves of the same risk groups were compared in order to evaluate the effect of nimodipine for the prevention of vasospasm following SAH. The delayed neurological deficits (DIND) and the functional outcome six months after the SAH were recorded in each group and compared. Nimodipine given within four days after the SAH did not prevent vasospasm evaluated by TCD, but it significantly reduced the severity of the vasoconstriction, especially in high-risk patients. It reduced significantly the incidence of DIND in high-risk patients and improved their functional outcome. Although nimodipine may have a reduced efficacy in preventing vasospasm after early operation of high-risk patients, it probably protects the brain by increasing its tolerance to focal ischaemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01402363
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  • 5
    Electronic Resource
    Electronic Resource
    Central Lumbar Disc Herniation (2000)
    Springer
    Acta neurochirurgica 142 (2000), S. 1369-1375 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Central; lumbar disc herniation; outcome; surgery.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  A follow-up study which describes the experience of the Department of Neurosurgery in Berne in the treatment of patients with central lumbar disc herniation (CLDH).  Background Data. The anatomical position of lumbar disc herniation, in general, does not seem to affect postoperative outcome. However, according to other studies a subgroup of patients with central lumbar disc herniations appears to have poorer results.  Objectives. The aim of the present study was to assess clinical outcome in a recent cohort of patients, to investigate whether there is a difference in outcome with regard to the surgical approach (unilateral vs bilateral) and to compare the postoperative results between the subcategories of CLDH: central massprolaps (CMP) and central contained disc herniation (CCDH).  Methods. Between 1990 and 1997, 40 out of 3150 patients operated on for lumbar disc herniation were diagnosed with CLDH (1.2%). The patients were operated on through unilateral or bilateral fenestrations with microdiscectomy. Recent follow-up studies were obtained by standardized questionnaires. The retrospective investigation was performed by an unbiased observer.  Results. Long-term follow-up was available for 34 of the 40 patients (85%) at a mean of 3.3 years. Eight patients had an excellent result (24%), 15 patients a good result (44%), 8 patients a fair (24%) and 3 patients had a poor result (9%). Overall, the operation was considered successful in 68% of patients. There was no statistically significant difference in outcome in patients with CMP as compared with those with CCDH (75% versus 64%). There was also no significant difference for better outcome between bilateral as compared with unilateral approaches.  Conclusions. Postoperative outcome of central lumbar disc herniation (CLDH) is poorer as compared with other types of lumbar disc herniation. The reason seems to be the anatomical position of the disc herniation with a peculiar derangement of the disc architecture. The surgical approach itself or the subcategories of CLDH appear to have only minor impact on postoperative outcome. Interlaminar fenestrations, in general, are appropriate for removal of the disc fragments.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010070007
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  • 6
    Electronic Resource
    Electronic Resource
    Current pattern of in-hospital aneurysmal rebleeds (1994)
    Springer
    Acta neurochirurgica 127 (1994), S. 21-26 
    Details
    ISSN: 0942-0940
    Keywords: Cerebral aneurysm ; nimodipine ; prognosis ; rebleed ; subarachnoid haemorrhage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The management of aneurysmal subarachnoid haemorrhage has recently changed considerably. Emergency admission to specialized centres and early surgery have become common practice. In addition, the use of nimodipine has gained widespread acceptance. Little data are available concerning the frequency and temporal profile of reruptures under the current policies. The case histories of 387 patients treated for aneurysmal subarachnoid haemorrhage between January 1984 and March 1992 were reviewed with regard to the incidence of in-hospital reruptures. All patients were managed according to the same protocol including a policy of individually timed early surgery and intravenous nimodipine. A total of 44 first in-hospital rebleeds were observed during the waiting period. Two percent of the patients admitted on the day of haemorrhage had a rebleed on the same day after admission to the hospital. No rebleeds were observed on the day after subarachnoid haemorrhage. Rebleed rates on day 2 and 3 were also low with 0.6 and 0.8% of the population with an undipped aneurysm. For the following 10 days, the daily rate of rerupture increased. A further peak was observed during the 4th week. Using life-table methods, the cumulative rate of rebleeds was calculated as 23% within 2 weeks and 42% within 4 weeks. Although patients suffering rebleeds differed in several respects from patients without rebleeds, most of the differences could be identified to be a consequence of a selection bias resulting in a longer period of exposure to the risk of rerupture for certain subgroups. Only patients suffering a loss of consciousness after the initial subarachnoid haemorrhage were definitively exposed to a higher daily risk of rerupture. Comparison with other series suggests that nimodipine treatment may add to the protective effect of bedrest, control of blood pressure and stress deprivation during the first days after subarachnoid haemorrhage. However, it cannot be excluded that withdrawal of nimodipine together with the general precautions in patients with unclipped aneurysms is responsible for the late peak of rebleeds. With regard to the timing of surgery, the low rebleed rates between days 1 and 3 justify semi-elective timing within this interval. On the other hand, in patients in whom aneurysm elimination has been deferred because of bad neurological condition or concomittant medical problems, surgery should be performed prior to the 4th week, unless the prognosis is considered hopeless at this time.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01808541
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  • 7
    Electronic Resource
    Electronic Resource
    Surgical Treatment of Lumbar Spinal Stenosis in the Elderly (1998)
    Springer
    Acta neurochirurgica 140 (1998), S. 637-641 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Lumbar spine; spinal stenosis; therapy; age ; elderly.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  148 elderly patients, aged 70 years or more, diagnosed as having lumbar spinal stenosis, were operated upon at our institution during 1983 to 1995. Totally 161 operative procedures were performed. We analysed retrospectively the results of the surgical treatment.  The most frequently performed procedure was multisegmental laminectomy, in 32% interlaminar fenestration and laminotomy were done. In 9 cases fusion was indicated, two of them being secondary operations. The mean hospital stay was 11 days. The morbidity was 6%, and there was one fatality (0.6%). The outcome was determined according to the six-grade classification proposed by Pappas and Sonntag [25]. Overall, in 91% of cases satisfactory-to-excellent result could be achieved.  We conclude, that in elderly patients with symptomatic lumbar spinal stenosis, with no evidence of instability, decompressive surgery without stabilisation can be done in the majority of patients with low morbidity and high expectation of clinical improvement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050155
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  • 8
    Electronic Resource
    Electronic Resource
    Early prognosis of supratentorial grade 2 astrocytomas in adult patients after resection or stereotactic biopsy (1990)
    Springer
    Acta neurochirurgica 106 (1990), S. 99-105 
    Details
    ISSN: 0942-0940
    Keywords: Astrocytoma ; brain neoplasm ; outcome ; prognosis ; epilepsy ; radiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 50 adult supratentorial low-grade astrocytomas operated upon between 1984 and 1988 were analysed retrospectively with respect to postoperative condition and progression-free survival. Pilocytic lesions were excluded. In 32 instances the tumour was macroscopically completely removed and partially in 4. In 14 cases a stereotactic biopsy was performed only. 10 patients received postoperative radiotherapy with 55 to 65 Gy. 1 patient died perioperatively from pulmonary embolism. 39 patients could resume their previous activities after discharge from the hospital, 10 were significantly disabled by neurological deficit, reduced neuropsychological performance or medically intractable epilepsy. Postoperatively, most patients required continuous anti-epileptic medication. 10 recurrences or tumour progressions of incompletely removed or merely biopsied lesions were observed within the mean follow-up period of 22 months. All recurrences after gross total removal, that were reoperated, had progressed to a malignant glioma. Of the prognostic tumour characteristics analysed, a histologically well-delineated tumour demarcation was most clearly associated with a favourable prognosis. Concerning treatment modalities, gross total resection was associated with a favourable prognosis. Radiotherapy was associated with an unfavourable outcome but this is probably due to selection of otherwise unfavourable cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01809449
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  • 9
    Electronic Resource
    Electronic Resource
    Morbidity and mortality of carotid endarterectomy (1987)
    Springer
    Acta neurochirurgica 84 (1987), S. 3-12 
    Details
    ISSN: 0942-0940
    Keywords: Carotid endarterectomy ; mortality ; morbidity ; literature review
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A review of the mortality and morbidity of carotid endarterectomy reported during the last 10 years was made and compared to the risk of carotid stenosis managed by the best medical treatment. For comparison, the patients were classified in asymptomatic patients (grade I), patients with transient ischaemic attacks (grade II), patients with ischaemic neurological deficits operated on acutely (grade III) and into patients with no or incomplete recovery 4–6 weeks after the stroke (grade IV). Based on the results of this literature review, only patients in grade II seem to benefit from carotid endarterectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01456344
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  • 10
    Electronic Resource
    Electronic Resource
    Effects of creatine treatment on survival and differentiation of GABA-ergic neurons in cultured striatal tissue (2005)
    Oxford, UK : Blackwell Science Ltd
    Journal of neurochemistry 95 (2005), S. 0 
    Details
    ISSN: 1471-4159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder, characterized by a prominent loss of GABA-ergic medium-sized spiny neurons in the caudate putamen. There is evidence that impaired energy metabolism contributes to neuronal death in HD. Creatine is an endogenous substrate for creatine kinases and thereby supports cellular ATP levels. This study investigated the effects of creatine supplementation (5 mm) on cell survival and neuronal differentiation in striatal cultures. Chronic creatine treatment resulted in significant increased densities of GABA-immunoreactive (-ir) neurons, although total neuronal cell number and general viability were not affected. Similar effects were seen after short-term treatment, suggesting that creatine acted as a differentiation factor. Inhibitors of transcription or translation did not abolish the creatine-mediated effects, nor did omission of extracellular calcium, whereas inhibition of mitogen-activated protein kinase and phosphatidylinositol-3-kinase significantly attenuated the creatine induced increase in GABA-ir cell densities. Creatine exhibited significant neuroprotection against toxicity instigated either by glucose- and serum deprivation or addition of 3-nitropropionic acid. In sum, the neuroprotective properties in combination with promotion of neuronal differentiation suggest that creatine has potential as a therapeutic drug in the treatment of neurodegenerative diseases, like HD.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-4159.2005.03337.x
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