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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 105 (1990), S. 5-13 
    ISSN: 0942-0940
    Keywords: Intraoperative ultrasound imaging ; ultrasound-guided stereotaxy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Intraoperative real-time ultrasound imaging (US) was used in over 500 patients to investigate which of the previously considered applications are of practical use in everyday neurosurgery. During all intraoperative applications for a wide variety of pathological conditions, small deep-seated as well as subcortically located lesions were detected with accuracy; in many instances they could be approached through smaller surgical exposures. US guidance was accurate in 209 cases for the stereotactic introduction of needles or endoscopes into various lesions: thus burrhole evacuation was performed on 148 intracerebral haematomas; in 16 patients endoscopic biopsy and resection of ventricular tumours was performed as well as biopsies of 39 hemispheric brain tumours and aspiration of a brain abscess in 6 instances. Seventy six gliomas were investigated by US imaging; the frequently unclear boundary between tumour and surrounding oedema was not better visualized than with CT or MRI. Moreover, US imaging for the detection of residual tumour towards the end of operation was unreliable. Postoperative imaging through burrholes or other cranial defects was mostly of unacceptably low quality for therapeutic decision making.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 104 (1990), S. 84-95 
    ISSN: 0942-0940
    Keywords: Real time intraoperative ultrasound imaging ; computerized tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Experience with the use of intraoperative ultrasound (US) imaging in over 300 patients are presented in this paper and discussed with special reference to various pathomorphologies as well as their identifiability within the brain/intracranium. In 201 of these patients, the pathomorphological peculiarities in US could be compared with preoperative CT findings. As a general result, all investigated lesions could be identified during intraoperative US investigations with the exception of small aneurysms. Most of the lesions gave at least partly higher echosignals than normal brain tissue, except arachnoid cysts. Size and shape of lesions were comparable in US and CT with the exception of some gliomas; in the latter group, the diffuse image in US was more akin to the situation likely to be found by the surgeon during operation, wheras CT used to give a misleading picture of a more or less clearly delineated tumour. US allowed more accurate differentiation between intratumoural necrosis and cysts than CT: the latter was misleading in many instances. At the present state of development, real time US imaging does not allow a histopathological diagnosis. The ease of handling and the high quality of morphological imaging, however, warrant a number of practical applications in daily neurosurgical practice.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 0942-0940
    Keywords: Digital subtraction cisternography ; CT cisternography ; MR cisternography ; CSF fistula
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Exact preoperative localization of the dural defect is an essential requirement for successful surgery of CSF fistula. Eighteen digital subtraction cisternography (DSC) results reported here were performed upon 16 patients with CSF rhinorrhea and 1 patient with CSF otorrhea. The exact site of the dural lesion could be proved in 9 out of 11 cases with active CSF leakage. In 4 cases the fistula was located in the cribriform plate, whereas it was found in the planum sphenoidale and the middle cranial fossa in 2 and 3 cases respectively. The frontal basal cisterns could not be filled sufficiently with the contrast agent due to haematoma and a prefixed chiasm accompanied by arachnoid adhesions in two cases. DSC performed during the non-drip period (3 cases) and in patients suspected to have a CSF rhinorrhea (3 cases) did not reveal the site of leakage. The investigation was followed by CT cisternography which allowed delineation of the lesion in the coronal view. In addition. MR with heavily T 2-weighted images (modification of the rapid acquisition with relaxation enhancement imaging) was performed upon 6 cases out of which the CSF fistula could be demarcated clearly in 4 patients, three with a traumatic CSF leakage and the other with an encephalomeningocele. Surgery performed successfully in 9 cases confirmed the predicted site of dural dehiscence. Being a dynamic investigation making the actual site of the CSF fistula visible, DSC is recommended in addition to CT cisternography which continues to be the most sensitive method for diagnosing dural and bony defects. It is suggested that heavily T 2-weighted MR images are useful in detecting the fistula in severe CSF rhinorrhea.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 109 (1991), S. 26-29 
    ISSN: 0942-0940
    Keywords: Fibrin tissue adhesive sealant ; transsphenoidal operation ; CSF fistula ; pituitary tumour
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Fibrin glue (Beriplast, Behring or Tissucol, Immuno) was used for 126 sublabial transseptal transsphenoidal operations in 119 patients from April 1981 to March 1987 in a variety of sellar pathologies together with septal bone and spongycel to seal the sellar floor and the anterior wall of the sphenoid sinus. The incidence of postoperative rhinorrhea was 1.6%. A review of the literature revealed an incidence of 1.5%–9.6% with the use of autologous tissue for sellar packing such as fat or muscle; fibrin glue combined with autologous grafts led to postoperative rhinorrhea in 1%–4.4%. The present results support the view that sellar and sphenoidal sealing with fibrin glue instead of muscle or fat tissue does not raise the incidence of postoperative rhinorrhea.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 108 (1991), S. 134-139 
    ISSN: 0942-0940
    Keywords: Focal cerebral ischaemia ; hydroxyethyl-starch
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a model of focal cerebral ischaemia in the cat (transorbital occlusion of the middle cerebral artery for 60 minutes, thereafter 6 hours reperfusion by clip removal), hydroxyethyl-starch (HAES) (ELOHES; Leopold Pharma GmbH, Graz, Austria) was administered intravenously before and during the ischaemic episode as a 6% or as a 10% solution in a randomised manner (6 animals each group). The size of the developing cerebral infarct was not significantly different when comparing the 6% and the 10% group with the controls (SALINE). Collateral circulation to the infarct border (pial arteries on the suprasylvian gyrus) was also not significantly different between the two groups, except for the first hour of reperfusion, where vessels of the 6% group were wider than vessels of the 10% group. At the infarct border (ectosylvian gyrus) small resistance vessels were significantly more dilated in the 6% than in the 10% group both during the occlusion period and during the reperfusion episode after removal of the clip. Pial arteries dilated less in both HAES-groups than in the controls. It can be assumed, that HAES-incuded decrease of plasma viscosity led to an elevation of blood flow velocity and blood flow quantity (CBF). But the latter might be counteracted by autoregulation of CBF, i.e. vasoconstriction. Thus, a possible positive effect of HAES might in part be counteracted by autoregulation, which explaines that no significant therapeutic effect could be achieved.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 139 (1997), S. 875-882 
    ISSN: 0942-0940
    Keywords: Paediatric ; hydrocephalus ; shunt ; complication
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The validity of clinical studies on shunt-treated hydrocephalic patients is often hindered by inhomogeneity of the patient population examined, technical devices used, or by other specific factors. In an effort to introduce a homogeneous clinical study on hydrocephalic patients 66 hydrocephalic newborns and infants have been treated exclusively with CORDIS Orbis-Sigma Valve (OSV) System (CORDIS Corporation, Miami, USA) in 1990–1995. The results are compared with an equivalent group of 53 children treated with CODMAN Holter Valve (HV) System (CODMAN Inc., Randolph, USA) during a similar 5-year-period (e.g., 1986–1991). Searching for different reasons of shunt insufficiency in both groups demonstrates a more than double risk of shunt complication for ventriculo-atrial HV treated patients (VA-HV) in comparison with those treated ventriculo-peritoneally with OSV System (VP-OSV): 4.22 versus 1.98 mean surgical procedures per person. The different revision and survival rates are discussed and specific problems are mentioned.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 134 (1995), S. 100-107 
    ISSN: 0942-0940
    Keywords: Spinal emergencies ; spinal MRI ; fast imaging ; RARE
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We studied the diagnostic value of MRI in spinal emergency. One hundred patients were analyzed retrospectively and the MR-findings were compared with operative results or autopsy whenever available. The advantages of MRI compared to CT and conventional myelography are discussed. The limitations of MRI are addressed and the important features of appropriate diagnostic procedure are outlined with special attention to neurosurgical requirements.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 95 (1988), S. 57-60 
    ISSN: 0942-0940
    Keywords: Brain death ; transcranial Doppler (TCD)
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Ever since transplant surgery became a common procedure, the early diagnosis of irreversible cessation of cerebral function has become an important need. We made a comparative study of EEG, angiography and transcranial Doppler imaging in patients who fulfilled the clinical criteria for brain death. The imaging was performed with a 2 MHz pulsed Doppler system with a unique transcranial probe (EME, type TC2-64B). Intracranial reverberating flow patterns with counterbalancing forward and backward components of the blood column indicate flow arrest. Transcranial Doppler Sonography was found to be a practical, non invasive, early and reliable method for the diagnosis of arrest of the cerebral circulation.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 0942-0940
    Keywords: Cavernous malformation ; epilepsy ; surgery ; seizure control
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Of 168 patients operated on consecutively for a supratentorial cavernous malformation, 77 had seizures as the initial symptom. The effectiveness of surgery in controlling seizures and the risk of surgery were evaluated by retrospective review of the patients' charts. The follow-up period was 1 to 9 years (mean 39 months) and the review period totalled 284 lesion-years. Only two patients showed postoperative deterioration in neurological status (morbidity risk: 2.6%), no patient died (mortality: 0%). Sixty-eight (88.3%) patients were seizure-free after operation and five (6.5%) showed a marked reduction in the frequency of their seizures. This corresponds to an overall positive effect of surgery in 94.8% of the patients. There was no substantial evidence that excision of the haemosiderin-stained tissue around the cavernoma along with the lesion itself provided better results than resection of only the cavernoma. Better results with regard to seizure control, however, were associated with shorter duration of symptoms before surgery.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1471-4159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: Slices from human neocortex preincubated with [3H]serotonin ([3H]5-HT) were superfused and stimulated electrically to investigate whether the α2-adrenoceptors on serotonergic terminals can be stimulated by endogenous noradrenaline (NA) released from neighboring noradrenergic fibers. The stimulation-evoked 3H overflow, representing action potential-induced, exocytotic release of 5-HT, was depressed by the NA uptake blocker (+)-oxaprotiline. Rauwolscine (a mixed α2-adrenoceptor antagonist/5-HT autoreceptor agonist) or phentolamine [a combined α- adrenoceptor/5-HT autoreceptor antagonist; the latter drug in the presence of (+)-oxaprotiline] enhanced the release when the 5-HT autoreceptors had previously been blocked by metitepine. Under hypothermia the release of 5-HT was found to be decreased and that of NA to be increased; under these conditions idazoxan (an α2-adrenoceptor antagonist) enhanced the release of 5-HT. In neocortex slices from rats (+)-oxaprotiline similarly depressed the release of 5-HT (measured with the same methods) as in human tissue. When rats were pretreated with 6-hydroxydopamine, the inhibitory effect of exogenous NA on 5-HT release was increased, and in slices from rats pretreated with desipramine, it was decreased. In conclusion, α2-heteroreceptors can be activated by endogenous NA released from neighboring noradrenergic fibers. Because regulatory processes analogous to those in rats probably occur in humans as well, an up- or down-regulation of α2- heteroreceptors in depressed patients with a (pathological) decrease or a (therapeutic) enhancement of the noradrenergic neurotransmission may also be assumed to occur.
    Type of Medium: Electronic Resource
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