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  • 1
    Electronic Resource
    Electronic Resource
    Commercial external ventricular drainage sets: Unsolved safety and handling problems (1991)
    Springer
    Acta neurochirurgica 110 (1991), S. 49-56 
    Details
    ISSN: 0942-0940
    Keywords: CSF drainage ; external drainage ; drainage sets ; reliability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Twelve commercially available sets for drainage of cerebrospinal fluid were tested for handling, design, features for fixation of the ventricular catheter, reliability of the anti-reflux valve, obstruction, efficiency of the air ventilation filter caps, accuracy of flow measurement and adjustment of flow, quality of material, adjustment, and cost. All systems showed considerable deficiencies in their reliability and handling. None of them can be recommended without certain restrictions and they should all be revised.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01402048
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  • 2
    Electronic Resource
    Electronic Resource
    Postoperative spondylodiscitis: Results of a prospective study about the aetiology of spondylodiscitis after operation for lumbar disc herniation (1992)
    Springer
    Acta neurochirurgica 117 (1992), S. 149-152 
    Details
    ISSN: 0942-0940
    Keywords: Spondylodiscitis ; lumbar disc operation ; intraoperative contamination
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In 412 patients undergoing surgery for herniated lumbar discs from September 1986 to September 1987 and from January 1988 to July 1989 a microbiological specimen was taken from the intervertebral disc space and from the cover of the operating microscope. Also the tips of the wound drains were examined microbiologically after removal. 17% of the patients had a positive bacteriological culture from their intervertebral disc space; 12% of the specimen from the operating microscope were positive. These results favour the hypothesis that intra-operative contamination of the disc space, in contrast to haematogeneous spread, causes spondylodiscitis. On the other hand we saw during this time course only one case of clinical spondylodiscitis, which implies a possible involvement of other predisposing factors such as pre- or perioperative infections or compromised patient immunologically. It is also possible, that the routine application of local antibiotic or antiseptic solutions into the disc space at the end of the operation could decontaminate the operative site and prevent clinical infection despite positive culture findings.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01400612
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  • 3
    Electronic Resource
    Electronic Resource
    Chronic precentral stimulation in trigeminal neuropathic pain (1996)
    Springer
    Acta neurochirurgica 138 (1996), S. 1300-1306 
    Details
    ISSN: 0942-0940
    Keywords: Precentral stimulation ; anaesthesia dolorosa ; post herpetic neuralgia ; deafferentation pain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The results of Deep Brain Stimulation in deafferentation pain syndromes, in particular in thalamic pain, indicate that excellent long-term pain relief can hardly ever be achieved. We report 7 cases using Motor-Cortex-Stimulation for treating severe trigeminal neuropathic pain syndromes, i.e., dysaesthesia, anaesthesia dolorosa and postherpetic neuralgia. The first implantation of the stimulation device for precentral cerebral stimulation was performed in June 1993, the last in September 1995. In all but one case the impulse-generator was implanted after a successful period of test stimulation. Successful means a pain reduction of more than 50% as assessed with a Visual Analogue Scale. Excluding one case, in whom a prolonged focal seizure resulting in a postictal speech arrest occurred during test stimulation, there have been no operative complications and the postoperative course was uneventful. In all the other patients the pain inhibition appeared below the threshold for producting motor effects. Initially these patients reported a good to excellent pain relief. In three of 6 patients a good to excellent pain control was maintained for a follow-up period of 5 months to 2 years. In the remaining three patients the positive effect decreased over several months.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01411059
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  • 4
    Electronic Resource
    Electronic Resource
    Nimodipine: Evidence for clinically significant gastrointestinal side-effects (1990)
    Springer
    Acta neurochirurgica 102 (1990), S. 73-75 
    Details
    ISSN: 0942-0940
    Keywords: Subarachnoid haemorrhage ; nimodipine ; intestinal pseudo-obstruction ; paralytic ileus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Nimodipine, now widely used for treatment and prevention of cerebrovascular spasm, is regarded as a safe drug. Despite a preferential action on cerebral vessels, there is clinical and experimental evidence of effects on systemic vascular and intestinal smooth muscle cells. Gastro-intestinal side-effects, however, have not been reported in clinical studies dealing with treatment of vasospasm following subarachnoid haemorrhage. We report on a patient with subarachnoid haemorrhage who developed an acute life-threatening pseudo-obstruction of the colon, a variant of adynamic ileus, while being treated with intravenous nimodipine. The relationship between this complication and calcium antagonist therapy is discussed and therapeutic strategies are presented. We conclude that neurosurgeons and neurologists should be aware of calcium antagonist—related ileus in patients treated with nimodipine.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01402190
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  • 5
    Electronic Resource
    Electronic Resource
    Neuronavigation Methoden und Ausblick (1998)
    Springer
    Der Nervenarzt 69 (1998), S. 1029-1036 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Neuronavigation ; Rahmenlose Stereotaxie ; Bildgeführte Neurochirurgie ; Computerassistierte Chirurgie ; Neurochirurgische Operationsmethoden ; Key words Neuronavigation ; Frameless stereotaxy ; Image-guided neurosurgery ; Computer- assisted surgery ; Neurosurgery method
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary With the recent developments in computer technology and the improvements in modern neuroimaging, frame-based stereotactic guidance for open microsurgical procedures has been increasingly replaced by neuronavigation, also called frameless stereotaxy. It allows transfer of individual patientís images onto the operative field to assist the neurosurgeon intraoperatively in defining the tumor margins or identifying functionally important brain areas. The different localization techniques employed are articulated position-sensing arms, infrared or ultrasound systems working with the principle of satellite navigation and robotic systems integrated with the operating microscope. In 200 operations performed with different systems (arm-based, robotic and infrared) the method proved to be helpful, enabling fewer invasive procedures to be performed. With a mean deviation of 2.87±1.9 mm for intraoperative localization, the accuracy was only slightly worse than in frame-based stereotaxy with deviations below 2 mm. Neuronavigation was most helpful for operations on deeply seated lesions, skull-base tumors and lesions in brain areas with high functionality. The major disadvantage is the use of preoperative data for navigation, leading to inaccuracies when anatomical structures are altered during the operation by resection of tumors or shift of intracranial soft tissue. Intraoperative magnetic resonance imaging (MRI) might be a solution for this problem. With the method of intraoperative MRI developed in our department it has already been possible to update neuronavigation with images reflecting intraoperative changes in anatomy. Therefore, neuronavigation is definitely a method with growing importance in operative routine, and it will also spread into other surgical specialties.
    Notes: Zusammenfassung Mit den Fortschritten in der Computertechnologie und der neuroradiologischen Bildgebung wurde die Entwicklung der Neuronavigation möglich. Diese wird seither immer häufiger angewendet und hat die rahmenbasierte Stereotaxie zur intraoperativen Führung bei mikrochirurgischen, intrakraniellen Operationen weitgehend abgelöst. Mit Hilfe von dreidimensionalen Digitalisierinstrumenten werden dabei die präoperativ angefertigten CT- oder MRT- Bilder eines Patienten währen der Operation auf den Operationssitus übertragen. So wird eine genaue Lokalisation von Läsionen wie Tumoren oder anatomischen Strukturen ermöglicht. Die verwendeten Techniken wie positionsfühlende Gelenkarme, Infrarot- oder Robotersysteme werden ebenso wie die Anwendung in der klinischen Routine dargestellt. In 200 Eingriffen, die mit Neuronavigation durchgeführt wurden, hat sich die Methode als sehr hilfreich zur minimal invasiven Eingriffsplanung und -durchführung erwiesen. Mit Abweichungen zwischen 2 und 4 mm ist die Genauigkeit nur geringfügig schlechter als die Werte, wie sie für die rahmenbasierte Stereotaxie angegeben werden. Als besonders vorteilhaft wurde die Navigation von den Operateuren bei Eingriffen an der Schädelbasis sowie kleinen, tiefliegenden oder in eloquenten Arealen gelegenen Läsionen eingestuft. Hauptnachteil der Methode ist die Verwendung von präoperativem Bildmaterial, was zu Ungenauigkeiten führt, wenn es im Verlauf einer Operation durch zunehmende Tumorresektion zu Veränderungen der Anatomie kommt. Hier könnten Verfahren der intraoperativen Bildgebung wie der MRT eine Lösung darstellen. So ist es uns bereits gelungen, durch Aktualisierung der Navigationsdaten mit intraoperativer MRT Verschiebungen auszugleichen. Diese Entwicklungen werden zu einer zunehmenden Bedeutung der Neuronavigation in der operativen Routine führen, was durch eine Senkung der Operationsmorbidität auch erhebliche Auswirkungen auf die Indikationsstellung zu neurochirurgischen Eingriffen haben wird.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050380
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  • 6
    Electronic Resource
    Electronic Resource
    Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils (1999)
    Springer
    Neuroradiology 41 (1999), S. 951-957 
    Details
    ISSN: 1432-1920
    Keywords: Key words Fistula ; arteriovenous ; Embolisation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report our experience in using Guglielmi electrolytically detachable coils (GDC) alone or in combination with other materials in the treatment of intracranial or cervical high-flow fistulae. We treated 14 patients with arteriovenous fistulae on brain-supplying vessels – three involving the external carotid or the vertebral artery, five the cavernous sinus and six the dural sinuses – by endovascular occlusion using electrolytically detachable platinum coils. The fistula was caused by trauma in six cases. In one case Ehlers-Danlos syndrome was the underlying disease, and in the remaining seven cases no aetiology could be found. Fistulae of the external carotid and vertebral arteries and caroticocavernous fistulae were reached via the transarterial route, while in all dural fistulae a combined transarterial-transvenous approach was chosen. All fistulae were treated using electrolytically detachable coils. While small fistulae could be occluded with electrolytically detachable coils alone, large fistulae were treated by using coils to build a stable basket for other types of coil or balloons. In 11 of the 14 patients, endovascular treatment resulted in complete occlusion of the fistula; in the remaining three occlusion was subtotal. Symptoms and signs were completely abolished by this treatment in 12 patients and reduced in 2. On clinical and neuroradiological follow-up (mean 16 months) no reappearance of symptoms was recorded.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050875
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  • 7
    Electronic Resource
    Electronic Resource
    Intraoperative MRI to control the extent of brain tumor surgery (1998)
    Springer
    Der Radiologe 38 (1998), S. 218-224 
    Details
    ISSN: 1432-2102
    Keywords: Key words Intraoperative • MRI • Brain tumor • Extend of resection • Image guided surgery ; Schlüsselwörter Intraoperativ • MRT • Hirntumor • Operationsradikalität • Neuronavigation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Auch für erfahrene Neurochirurgen ist es außerordentlich schwierig bis unmöglich, intraoperativ die Grenze eines hirneigenen Tumors zu erkennen und entsprechend dieser Grenze eine „Totalentfernung“ des Tumors durchzuführen. Verschiedene Studien zeigten die Unzuverlässigkeit der intraoperativen Einschätzung der Operationsradikalität. Während intraoperative CT-Kontrollen und intraoperative Ultraschallkontrollen bereits seit längerem eingesetzt werden, wurde der Magnetresonanztomographie – der bildgebenden Methode mit der höchsten Weichteilauflösung – dieser Anwendungsbereich erst kürzlich durch die Entwicklung „offener“ MR-Systeme erschlossen. Im Operationstrakt der neurochirurgischen Klinik der Universität Heidelberg wurde ein offener MR-Tomograph installiert, an dem neben Biopsieentnahmen und neurochirurgischen Interventionen auch intraoperative MR-Kontrollen der Operationsradikalität durchgeführt werden. Unsere ersten Erfahrungen deuten darauf hin, daß durch den Einsatz intraoperativer MRT die Operationsradikalität neurochirurgischer Eingriffe gesteigert werden kann. Allerdings war bei allen Patienten durch die chirurgische Manipulation selbst verursachtes Kontrastmittelenhancement nachweisbar, das z. T. Verwechslungspotential mit Resttumor besaß.
    Notes: Purpose: The main aim of our study was to find out whether the combined use of neuronavigation and intraoperative MRI can increase the rate of “complete tumor removal”. The second aim was to characterize the different forms of surgically induced enhancement in order to differentiate them from residual tumor. Materials and methods: Surgery was performed in 18 patients with high-grade glioma. Using a neuronavigation device, the surgeons operated up to the point where they would otherwise have terminated surgery. Intraoperative MRI was then performed to determine whether residual enhancing had been left behind and to update the neuronavigation device. If necessary, feasible surgery was continued. On days 1–3 after surgery early postoperative MRI (1.5 T) was performed. The proportion of patients in whom the enhancing tumor was completely removed was compared with a series of 60 patients with glioblastoma multiforme, who had been operated on using neither neuronavigation nor intraoperative MRI . We also looked for and characterized different types of surgically induced enhancement. Results: Intraoperative MRI definitely showed residual tumor in 6 of the 18 patients and resulted in ambiguous findings in 3 patients. In 7 patients surgery was continued. Early postoperative MRI showed residual tumor in 3 patients and resulted in uncertain findings in 2 patients. The rate of patients in whom complete removal of enhancing tumor could be achieved was 50 % at the time of the intraoperative MR examination and 72 % at the time of the early postoperative MR control. The difference in proportion of patients with “complete tumor removal” between the groups who had been operated on using neuronavigation (NN) and intraoperative MRI (ioMRI) and those who had been operated on using only modern neurosurgical techniques except NN and ioMRI was statistically highly significant (Fisher exact test; P = 0.008). Four different types of surgically induced contrast enhancement were observed. These phenomena carry different confounding potentials with residual tumor. Conclusion: Our preliminary experience with intraoperative MRI in patients with enhancing intraaxial tumors is encouraging. Combined use of neuronavigation and intraoperative MRI was able to increase the proportion of patients in whom complete removal of the enhancing parts of the tumor was achieved. Surgically induced enhancement requires careful analysis of the intraoperative MRI in order not to confuse it with residual tumor.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050345
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  • 8
    Electronic Resource
    Electronic Resource
    Epidurale Kortikosteroid- injektionen im Lumbalbereich (2000)
    Springer
    Der Schmerz 14 (2000), S. 42-44 
    Details
    ISSN: 1432-2129
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004820050011
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  • 9
    Electronic Resource
    Electronic Resource
    Virtuelle Realität in der Neurochirurgie (2000)
    Springer
    Der Radiologe 40 (2000), S. 211-217 
    Details
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Computerassistierte Neurochirurgie ; Computerintegrierte Neurochirurgie ; Neuronavigation ; Robotik ; Telemedizin ; Telechirurgie ; Virtuelle Realität ; Key words Computer-assisted neurosurgery ; Computer-integrated neurosurgery ; Neuronavigation ; Robotics ; Telemedicine ; Telesurgery ; Virtual reality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Definition: Virtual reality enables users to immerse themselves in a virtual three-dimensional world and to interact in this world. The simulation is different from the kind in computer games, in which the viewer is active but acts in a nonrealistic world, or on the TV screen, where we are passively driven in an active world. In virtual reality elements look realistic, they change their characteristics and have almost real-world unpredictability. Use of virtual reality: Virtual reality is not only implemented in gambling dens and the entertainment industry but also in manufacturing processes (cars, furniture etc.), military applications and medicine. Especially the last two areas are strongly correlated, because telemedicine or telesurgery was originated for military reasons to operate on war victims from a secure distance or to perform surgery on astronauts in an orbiting space station. In medicine and especially neurosurgery virtual-reality methods are used for education, surgical planning and simulation on a virtual patient.
    Notes: Zusammenfassung Definition: Virtuelle Realität (VR) erlaubt dem Benutzer, in eine dreidimensionale Welt einzutauchen (engl.: to immerse, daher immersive VR) und in dieser virtuellen Welt zu agieren. Damit unterscheidet sich die VR von den bekannten Vorstellungen, z.B. in Computerspielen, wo man aktiv in einer irrealen Welt agiert, oder in Spielfilmen, wo man passiv an einer realen Welt teilnimmt. In der virtuellen Realität agiert man aktiv in einer Welt mit realistisch erscheinenden Elementen, die ihr Erscheinungsbild ändern können und daher „weitgehend unberechenbar” sind. Anwendung: Virtuelle Realität hat den Einzug nicht nur in Spielhallen und die Unterhaltungsindustrie gefunden, sondern auch in industrielle Fertigungsanlagen (Autos, Möbel usw.), militärische Bereiche und die Medizin. Gerade die beiden letzten Bereiche sind eng verknüpft, denn mit dem Begriff Telemedizin verband sich ursprünglich die Idee, im Kriegsfall Operationen an verwundeten Soldaten mit ferngesteuerten Robotern aus sicherem Abstand heraus durchzuführen oder Astronauten von der Erde aus zu behandeln. In der Medizin, speziell in der Neurochirurgie, werden heute bereits virtuelle Methoden zu Ausbildungszwecken, zur Operationsplanung und zu Operationen am virtuellen Patienten eingesetzt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050659
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