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  • 1
    Electronic Resource
    Electronic Resource
    Dorsal root repair by means of an autologous nerve graft: Experimental study in the rat (1997)
    Springer
    Acta neurochirurgica 139 (1997), S. 780-786 
    Details
    ISSN: 0942-0940
    Keywords: Dorsal root ; nerve graft ; spinal cord ; posterior horn ; surgical repair
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Rat dorsal root regeneration was studied after 6th and 7th cervical root surgical removal and replacement with an autologous graft of peripheral nerve harvested from the surval nerve from dorsal root ganglion to dorsal horn. Histological studies showed axonal regeneration within the grafts. When the distal end of the graft was placed inside the posterior horn of the spinal cord by use of a myelotomy, axonal sprouts (revealed by the transganglionic staining method of horseradish peroxidase or HSP) reached the neurones of the posterior horn in a limited fashion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01420053
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  • 2
    Electronic Resource
    Electronic Resource
    Surgical treatment of anterior skull base tumours (1997)
    Springer
    Acta neurochirurgica 139 (1997), S. 857-868 
    Details
    ISSN: 0942-0940
    Keywords: Skull base tumours ; skull base surgery ; skull base reconstruction ; flaps for anterior skull base reconstruction ; autoclaved bone ; pericranium flap
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Skull base tumours represent a special challenge to surgeons due to the complex anatomy of the area. While small tumours are easy to remove, large lesions can pose complex situations. The most difficult aspects are not only the approach and removal, but specially the repair of the defects created by the resection of the tumour. We present here our experience with the surgical removal of tumours on the anterior skull base. To achieve a good approach, we resort to a bifrontal craniotomy including the cilliar arches. To obtain a skull base bone flap that can be used for repair at the end of the procedure, we remove the roof of the nose and a part of the medial wall and roof of both orbits. While the tumour is removed, the skull base bone flap is autoclaved to kill all tumoural cells. At the end of the procedure this bone flap is replaced, wrapped with a flap of pericranium. Provided no orbit needs to be emptied, no other flap is needed to reconstruct the area. One advantage is that the surgical cavity is not occluded with tissues, thus facilitating early identification of any recurrence. The area can be explored with the aid of an endoscope introduced into the nasal cavities through the nostrils, and in case of doubt, biopsies taken from all suspicious areas. Our technique facilitates the repair of the surgical defect, and while not compromising the healing process it has a very low incidence of CSF leaks and infections.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01411404
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  • 3
    Electronic Resource
    Electronic Resource
    Surgical treatment of insular gliomas (1997)
    Springer
    Acta neurochirurgica 139 (1997), S. 1126-1135 
    Details
    ISSN: 0942-0940
    Keywords: Insula ; surgery gliomas ; internal capsule ; Sylvian fissure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Surgical treatment of glial tumours arising in the insula is specially challenging due to the proximity of the internal capsule. Although small insular gliomas have been removed safely by a transylvian approach, in large dominant insular tumours only biopsy has been recommended to avoid postoperative deficits. Unfortunately that is a suboptimal form of treatment as low grade supratentorial gliomas should be removed radically to prevent tumour progression, malignization and to increase the recurrence-free-interval. Addition of radiotherapy to partial removal is associated with a much higher incidence of recurrences and early malignizations compared to radical removal and no radiotherapy. Between 1st October 1989 and 1st September 1996 we treated twenty-three patients harbouring insular gliomas. To increase the radicality of the resection the surgical procedure was performed under local anaesthesia whenever possible, as general anaesthesia usually leads to more conservative resections. In 20/23 (86.9%) patients complete resection was accomplished, and subtotal in three (13.1%). The removed tumours were: two oligodendrogliomas, five grade I astrocytomas, nine grade II, four grade III and three grade IV. Postoperative neurological deficits occurred in five patients. Four suffered a hemiparesis (that recovered in an average of 6 months) and one a motor dysphasia which took a week to recover. Two of the seventeen patients operated on for low grade insular gliomas underwent malignant change. We conclude that complete surgical removal of insular gliomas should be considered and at least attempted in all cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01410972
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  • 4
    Electronic Resource
    Electronic Resource
    Use of frozen cranial vault bone allografts in the repair of extensive cranial bone defects (1997)
    Springer
    Acta neurochirurgica 139 (1997), S. 653-660 
    Details
    ISSN: 0942-0940
    Keywords: Cranioplasty ; bone transplantation ; cryopreservation ; bone resorption ; bone substitutes ; bone graft
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In cranioplasty complexity is proportional to the size of the defect, particularly if greater than 50 cm2. If the patient's own bone flap is not available, allogenic frozen bone graft can be used instead. Between June 1990 and June 1995 twenty cranioplasties with allogenic frozen bone grafts were performed. Age of patients ranged between 23 and 63 years (average 38.4 years). Male/female ratio was 2 ∶ 1.7. Size of craniectomy ranged between 65 and 150 cm2 (average 83.3 cm2). Follow-up ranged between 10 and 58 months (average 41 months). Donors were tested to rule out transmissible diseases, infections, sepsis and/or cancer. Bone grafts were removed under aseptic conditions, microbiological cultures were taken, wrapped in a gauze soaked with Gentamicin sulphate and Bacitracin, sealed in three sterilised vinyl plastic bags, and stored in a deep freezer for a minimum of 30 days (range 36–93 days, average 67 days), at a temperature of −80 °C. Grafts were placed in the defect after a step was carved on its borders to facilitate the contact between host and graft. Vancomycin 1 g. IV/12 hours and Ceftriaxone 1 g. IV/12 hours were administered for five days. Grafts were covered by means of scalp flaps. Only one required a musculocutaneous free flap. None was exposed, extruded or had to be removed. Plain skull X-ray studies showed progressive remodelling of the grafts. Partial resorption was observed in two (2/20, 10%) and loss of thickness in another 3/20 (15%), but with no changes in the contour. Biopsies were taken in 3/20 (15%) cases at a second surgical procedure. Areas of osteoclastic resorptive activity mixed with others of osteoblastic bone apposition, showed replacement with new bone. We conclude that cranial vault frozen allografts are a good alternative to autologous bone when the latter is absent or not present in sufficient amount.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01412001
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  • 5
    Electronic Resource
    Electronic Resource
    Shunt malfunction in relation to shunt infection (1996)
    Springer
    Acta neurochirurgica 138 (1996), S. 829-834 
    Details
    ISSN: 0942-0940
    Keywords: Shunt infection ; hydrocephalus ; infection ; ventriculo-peritoneal shunt ; external ventricular drainage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Ventriculo-peritoneal shunt malfunction may be caused by shunt infection which may not be clinically apparent as the cause of the malfunction by standard diagnostic criteria. This suggests that the real incidence of infected shunts might be higher than previously suspected. In order to study the relationship between infection and shunt malfunction, we followed a protocol over five years (54 V-P shunts) consisting of (1) removal of the malfunctioning shunt and replacement in the same surgical procedure with a new one or institution of an external ventricular drainage for 8 days (if there were clear signs of infection), (2) culturing of CSF and every part of the removed shunt, and (3) intravenous antibiotic treatment (Vancomycin 1g./12h + Ceftriaxone 1g./12h) for five days after the new V-P shunt had been inserted. In those cases in which an external ventricular drainage had been placed, its tip and a portion of the new V-P shunt were also cultured. The results showed that although CSF cultures were negative in 49/54 cases (90.7%), cultures of the removed shunts were positive in 32/54 (59.2%), most of them (21/32, 65.6%) for Staphylococcus coagulase negative organisms. The CSF samples obtained by puncturing the reservoir on admission to Hospital were positive only in 5 out of 54 cases (9.2%), only in those showing clinical features of infection. In the remaining cases, 27 out of 54 (50%) the CSF cultures were negative but the shunt cultures proved positive and required further treatment. For the newly inserted shunts (173) CSF was collected through the shunt during the surgical procedure, and a small piece of the extra-tube from the ventricular and from the peritoneal catheter were obtained and cultured. All the six shunts (6/173, 3.4%) that showed positive cultures after insertion had to be replaced within a period of three to four weeks due to malfunction (range 26±7 days), indicating that the systematic culture of CSF and tubing helps to predict which shunts will soon need to be replaced due to infection. We conclude that CSF culture alone does not rule out infection in cases of shunt malfunction. The percutaneous CSF obtained from the shunt reservoir on admission is particularly prone to show negative cultures even when the shunt is colonized by bacteria.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01411261
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  • 6
    Electronic Resource
    Electronic Resource
    Cranioplasty with autogenous autoclaved calvarial bone flap in the cases of tumoural invasion (1997)
    Springer
    Acta neurochirurgica 139 (1997), S. 970-976 
    Details
    ISSN: 0942-0940
    Keywords: Cranioplasty ; bone graft ; bone transplantation ; autoclaving ; bone resorption
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary When a bone flap is raised in the course of a craniotomy, the ideal is to replace it at the end of the procedure. When it is invaded by tumoural cells, it cannot be replaced due to the risk of tumoural recurrence. In these cases we have autoclaved the bone flap to be able to replace it with no fear of tumoural recurrence. Between October 1989 and October 1995 sixty-two patients required autoclaving of the bone flap in the course of a craniotomy due to tumoural invasion (thirty-five meningiomas, sixteen bone tumours, five metastases, and eight scalp tumours). The infiltrated bone flaps were removed, cleaned, autoclaved for 20 minutes at 134 °C and 1 kg/cm2 and re-implanted. Patients were followed-up for 10 to 58 months (average 41 months). At every follow-up visit skull x-ray studies, clinical examination, and photographs were done. When needed a CT scan was performed to assess the thickness of the bone flap. On follow-up roentgenograms partial resorption was observed in twelve cases (19.3%). CT scan studies showed loss of thickness in another thirty-five cases (56.4%). Meanwhile the external aspect remained unchanged. In six cases (3.2%) biopsies of the bone flaps were taken at a second surgical procedure. They showed newly formed bone partly re-populated by osteocytes but retaining areas of sequestered bone. We conclude that autoclaved bone, if replaced with direct contact with living bone, it is gradually repopulated with osteocytes. Cranial vault autoclaved autologous bone flap is a good alternative when the original bone flap is invaded but not destroyed by tumoural cells.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01411307
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  • 7
    Electronic Resource
    Electronic Resource
    Repair of Dural Defects in Awkward Areas-Technical Note (1998)
    Springer
    Acta neurochirurgica 140 (1998), S. 615-618 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Cerebrospinal fluid leak; dural closure ; dural suturing; dura mater surgery.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  Dural tears located at the base of the skull are difficult to repair due to the difficulties in the appropriate access and the fragility of the dura in such areas.  In our experience the biggest problem when attempting to perform a dural repair in a deep narrow field is not to place the stitches, but rather to set the knots. A newly designed, easy-to-learn technique has been developed for dural closure in these situations. We present here a new technique for dural suturing of special interest when the space available is limited.  In our hands it is possible to obtain a watertight dural closure in most microsurgical operations performed through a small hole and/or into a narrow, deep surgical field. These techniques can also be applied during a secondary procedure following development of a postoperative CSF leak. While simple and easy to learn, these techniques require practice in the laboratory setting before clinical application.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050149
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  • 8
    Electronic Resource
    Electronic Resource
    Drug-induced hypersensitivity syndrome and toxic epidermal necrolysis. Treatment with N-acetylcysteine (1997)
    Oxford, UK : Blackwell Publishing Ltd
    British journal of dermatology 136 (1997), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2133.1997.tb02175.x
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