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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 123 (1993), S. 52-56 
    ISSN: 0942-0940
    Keywords: Failed back surgery syndrome ; post-operative lumbosacral CT scan ; intervertebral disc ; micro-discectomy ; herniatedlumbar disc
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 40 patients underwent lumbosacral microdiscectomy in a 12 months period covering the years 1988–1989 in our center. For the purpose of the present study, we considered the 30 cases who underwent CT control of the operated interspaces and of the adjacent vertebral endplates. This was routinely carried out on the 3rd postoperative day. The present study failed to show correlations between early post-operative CT data and subsequent clinical results in this unselected series of patients. In fact an image suggesting persistent disc herniation was as a rule observed in spite of satisfactory clinical results, and other CT findings that have been considered of clinical significance, such as intraspinal air and low attenuation of disc space, were commonly observed in patients with an uncomplicated postoperative course. The present study suggests that early post-operative CT appears to be of no value in the management of potential early complications of low-back surgery. The introduction of MRI appears to offer other possibilities in the evaluation and management of failed back surgery syndrome (FBSS).
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 0942-0940
    Keywords: MRI ; spine ; intervertebral disc hernia Gadolinium
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The aim of our study was to evaluate the contrast-enhanced MR imaging (MRI) findings, in the early postoperative period, in unselected patients undergoing lumbar microdiscectomy (15/16 had total resolution of their symptoms). Contrast-enhanced imaging studies were performed, in all 16 patients of our series, before surgery, and at the third postoperative day and, two months after surgery. Postoperative paraspinal muscles enhancement was present in all patients. In the postoperative period, nerve root enhancement was present in 5/16 patients at the early survey and persisted in one after two months. A pseudohernia depicted as epidural intermediate signal intensity tissue, was seen in 13 patients at the third day MRI, and only in eight after two months. This pseudohernia enhanced peripherally in 8/13 patients and enhanced homogeneously in the remaining five at the first postsurgical examination; in the late MRI the peripheral enhancement was appreciable in only two patients while a homogeneous enhancement was observed in six. Clinical symptoms resolved completely in 14/16 patients on clinical evaluation at the third postoperative day, while the remaining two patients showed residual symptoms and signs of radicular compression. At the early MRI these two patients showed intradural nerve root enhancement. Two months later, one patient did not show the previously described nerve root enhancement and improved clinically, while the other had a positive Straight Leg Raising Sign with persistent intradural nerve root enhancement. In conclusion, no correlation between clinical course and contrastenhancement of pseudohernia and extradural nerve root was appreciable, although intradural nerve root enhancement seems to represent a clinically relevant finding.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 63 (1982), S. 245-250 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The results of two different antifibrinolytic therapeutic modalities (A = AMCA 3gm daily + Aprotinin, 3–400000 K.I.U daily, B=AMCA, 6 gm daily) were compared retrospectively in a series of 137 patients harbouring recently ruptured intracranial aneurysms. The rates for rebleeding and thromboembolic complications were similar in both differently treated groups of patients, whilst that for ischaemic complications was significantly (p〈0.025) lower in cases managed with modality A. In these also the incidence of hydrocephalus was decreased, although not significantly (0.20〉p 〉0.19). According to these data, low-dose AMCA + Aprotinin seems to be a rational therapeutic combination for cases of ruptured intracranial aneurysms, in which antifibrinolytics are indicated.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 0942-0940
    Keywords: Glioma ; meningioma ; coincidental intracranial tumours
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The simultaneous occurrence of meningioma and glioma is extremely rare. Three new cases and 54 adequately described in the literature are analyzed. Clinical diagnosis may be difficult due to discrepancy between clinical and radiological findings. Unexpected clinical deterioration following removal of a tumour and relapse simulating recurrence may occur. The introduction of CT technology does not seem to have offered the expected contribution to the early diagnosis of these coincidental lesions, at least before the introduction of the newer generation scanners or MRI. While removal of both tumours in one session yielded the best results, surgery for the sole glioma appeared to be associated with an unacceptably high mortality. Although several aetiopathogenetic hypotheses have been suggested for explaining this curious association, coincidental meningioma and glioma are most likely to be different primary brain tumours occurring randomly in the same individual.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 0942-0940
    Keywords: Surgical technique ; facial nerve ; pterional-transzygomatic craniotomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The temporal branch of the facial nerve may be saved in a pterional-transzygomatic craniotomy if the dissection is carried beneath the superficial temporal fascia. The anatomical and technical aspects of this exposure are described in this report.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 80 (1986), S. 12-17 
    ISSN: 0942-0940
    Keywords: Medium and long term prognosis ; negative angiographic findings ; subarachnoid haemorrhage, spontaneous
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This study concerns 64 patients with angiographically negative subarachnoid haemorrhage (SAH) hospitalized in the period 1970–1982. Requisites for inclusion in the study were adequate angiographic demonstration of the carotid and vertebrobasilar systems and no clinical signs of spinal SAH or spontaneous intracerebral haematoma. The clinical data on the 64 cases confirm the close similarity, except for the prognostic factors, between angiographically negative SAH and SAH secondary to rupture of an intracranial saccular aneurysm. The study underlines the benign character of the clinical course and of the medium and long-term prognosis of the condition under study. In view of this, the hypothesis advanced sometime ago relating angiographically negative SAH to the rupture of microaneurysms (Ø〈2 mm) of the large cerebral arteries with subsequent complete repair of the artery wall, or to the spontaneous thrombosis of intracranial saccular aneurysms, with the possibility of subsequent recanalization and risk of fresh rupture, would appear to be a reasonable one.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 48 (1979), S. 111-120 
    ISSN: 0942-0940
    Keywords: Osteoclastoma ; Vertebral column radiotherapy ; Vertebral body removal
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A rare case of vertebral osteoclastoma in the body of T8 is presented. Attention is drawn to its unusual radiological features, not previously reported, and to the relative inefficiency of radiotherapy. The most rational treatment for such a tumour appears to be the widest surgical decompression possible, followed by low-dose irradiation.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 58 (1981), S. 75-84 
    ISSN: 0942-0940
    Keywords: Benign intracranial hypertension ; pseudotumour cerebri ; intracranial arteriovenous malformation ; computerized tomography ; contrast enhancement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A nine-year-old boy, presenting only with signs of increased ICP, underwent computerized tomography. This examination demonstrated no abnormalities in the precontrast scan. Following C. E., it showed scattered areas of blood-like density in both hemispheres, as well as a presumedly abnormal vessel in the left occipital region and dilated vein of Galen, sinus rectus, and tentorial veins. The presumptive diagnosis of left occipital AVM was not confirmed by angiography, which also ruled out obstructions of the intracranial sinuses. The possible mechanism responsible for this atypical CT picture is briefly discussed in the light of pertinent literature. It is suggested that careful consideration should be given to the indications for angiography in similar cases, in the presence of a “hypervascular” aspect of the postcontrast CT scan, particularly if a considerable amount of contrast medium has been used.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 58 (1981), S. 105-114 
    ISSN: 0942-0940
    Keywords: Computed tomography ; spine ; spinal tumour ; osteochondroma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This paper reports two cases of spinal osteochondroma, in which preoperative diagnosis was greatly facilitated by CT scan examination. Moreover, by giving a precise indication of tumour extent, as well as of its relationships with the adjacent structures, CT was of great value also with regard to surgical treatment. Personal experience with the present cases, as well as a review of pertinent literature, suggests that the following CT scan findings may be considered as typical of spinal osteochondroma: a) roundish, sharply-outlined mass; b) bone-like density, with scattered calcifications; c) paraspinal, dumb-bell, or eccentric intraspinal location; d) osteosclerotic changes in neighbouring bone; e) lack of contrast enhancement. The value of CT scan examination in the diagnosis of vertebral tumours is stressed.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 0942-0940
    Keywords: Trigeminal neurinoma ; surgical management ; skull base surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Neurinomas arising from the trigeminal nerve are rare (0.1–0.4% of intracranial tumours; 1–8% of all intracranial neurinomas). A series of 111 trigeminal neurinomas operated on at the Institute of Neurosurgery “N. N. Burdenko” of Moscow, Russia, during the period 1961–1994 is presented. Clinical features, diagnostic radiology, surgery and results of treatment are discussed. We distinguished four groups of trigeminal neurinomas: a) Posterior fossa tumours; b) Tumours of the Gasserian ganglion; c) “Dumb-bell” supra-subtentorial tumours: d) Neurinomas of the peripheral branches. The complex clinical symptomatology is related to the actual location of the lesion. Surgery of trigeminal neurinomas may be very difficult, particularly in cases of dump-bell supra-subtentorial lesions. In this series, 3 cases died postoperatively. Out of the 108 patients surviving surgery, long-term follow-up (min. 13 months, max. 33 years, average 13.5 years) was available in 98 cases. 84 patients (86.7%) showed good-to excellent results, with partial trigeminal deficit as the only surgical sequela. 13 patients (11.7%) had a symptomatic recurrence following incomplete tumour removal. Second surgery, ranging from 1.4 to 9 years (average 3.8 years) following the first operation, was judged radical in 9 cases (69.2), however, the rate of complications of repeated surgery was higher than that occurring after the first operation. The advent of microsurgery, together with the introduction of the techniques of skull base surgery and of modern diagnostic imaging tools, have improved surgical results in terms of increased radicality and reduced complications.
    Type of Medium: Electronic Resource
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