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  • 1
    Electronic Resource
    Electronic Resource
    Surgical pathology of chronic epileptic seizure disorders: experience with 63 specimens from extratemporal corticectomies, lobectomies and functional hemispherectomies (1993)
    Springer
    Acta neuropathologica 86 (1993), S. 466-472 
    Details
    ISSN: 1432-0533
    Keywords: Epilepsy ; Pathology ; Tumor ; Malformation ; Inflammation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The surgical treatment of chronic pharmacoresistant epilepsies is increasing rapidly. Although several studies have reported on histopathological findings in temporal lobe epilepsy, little is known about the surgical pathology of other seizure disorders. Here we report the histopathological fingings in 63 consecutive surgical specimens of patients who were operated for chronic pharmacoresistant epileptic seizures other than temporal lobe epilepsy (37 corticectomies, 19 functional hemispherectomies, 5 lobectomies, 1 multilobectomy, and 1 frontal lobe deafferentiation combined with a temporal lobectomy). There were structural lesions in 85.7% of the specimens. In 16 cases (25.4%) the predominant lesions were malformative (focal glioneuronal hamartias and hamartomas, vascular malformations, abundant ectopic neurons in the white matter, microgyria, and arachnoid cyst). Lesions indicating preor perinatal necrosis such as porencephaly, ulegyria, and congenital hemiatrophy were present in 7 cases (11.1%). Twelve specimens (19.0%) contained low-grade neoplasms (7 gangliogliomas, 3 astrocytomas, 1 oligoden-droglioma and 1 oligoastrocytoma). There were 3 cases of Rasuussen encephalitis, 1 specimen with atrophy and gliosis due to previous herpetic encephalitis and 1 case with an old abscess wall. Posttraumatic or postoperative changes were the predominant finding in 7 specimens (11.1%). In 7 patients there were only nonspecific changes such as cortical atrophy and gliosis or old hemorrhage. No structural alterations were identified in 9 specimens (14.3%). The findings suggest that the structural lesions observed in the great majority of the specimens were closely related to the pathogenesis of intractable seizures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00228581
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  • 2
    Electronic Resource
    Electronic Resource
    Indocyanine green clearance and duplex sonography in hepatic blood flow (1992)
    Springer
    Journal of molecular medicine 70 (1992), S. 620-620 
    Details
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00184809
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Effect of propranolol on portal vein hemodynamics: assessment by duplex sonography and indocyanine green clearance in healthy volunteers (1993)
    Springer
    Journal of molecular medicine 71 (1993), S. 654-658 
    Details
    ISSN: 1432-1440
    Keywords: Portal hypertension ; Duplex sonography ; Indocyanine green clearance ; Propranolol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In the past decade several randomized trials have shown a beneficial effect of propranolol in cirrhotic patients. The effect of propranolol has been attributed to a reduction in portal vein pressure. So far the monitoring of portal vein hemodynamics following propranolol administration has been achieved mainly by hepatic vein catheterization. We studied the effect of propranolol on portal vein hemodynamics noninvasively in five healthy volunteers using duplex sonography and indocyanine green clearance. Measured by duplex sonography, blood flow was reduced by 28.6% in the portal vein (P〈0.05) and by 8.7% in the hepatic artery (NS) 60 min after oral administration of 80 mg propranolol. During this time total hepatic blood flow, measured by indocyanine green clearance, was reduced by 19.5% (P〈0.05). We conclude that both methods are useful for the study of portal vein hemodynamics during propranolol therapy, duplex sonography being more easily practicable.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00184496
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  • 4
    Electronic Resource
    Electronic Resource
    Safety of single and repetitive focal transcranial magnetic stimuli as assessed by intracranial EEG recordings in patients with partial epilepsy (1999)
    Springer
    Journal of neurology 246 (1999), S. 914-919 
    Details
    ISSN: 1432-1459
    Keywords: Key words Transcranial magnetic stimulation ; Repetitive ; Safety ; Intracranial EEG recording ; Epilepsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The safety of single and repetitive (paired and quadruple) focal transcranial magnetic stimuli as possible inducers of epileptic discharges or clinically manifest seizures was investigated in 21 patients with intractable epilepsy during invasive presurgical monitoring. Subdural and/or intracerebral depth electrodes had been implanted in close proximity to the suspected epileptogenic zone, and the anticonvulsant medication had been reduced. Focal transcranial magnetic stimuli were applied by a Magstim QuadroPulse magnetic stimulator over the hand area of the motor cortex ipsilateral to the epileptogenic focus at intensities of 120% and 150% of motor threshold and additionally as close as possible to the suspected epileptogenic zone at 40–100% of maximal stimulator output. Stimulation did not induce any complex partial or secondary generalized tonic-clonic seizures. One patient with hippocampal sclerosis experienced an aura associated with rhythmic electroencephalographic discharges restricted to the ipsilateral intrahippocampal depth electrode after stimulation over his left temporal lobe. This patient, however, also had frequent spontaneously occurring auras with focal ictal discharges originating from this hippocampus. Interictal discharges were not influenced significantly by single or repetitive magnetic stimuli. In conclusion, from this study there is no evidence that single or serial focal transcranial magnetic stimuli activate epileptogenic foci. At least four high-frequency repetitive stimuli of high intensity may thus be applied with a low risk of seizure induction even in patients with low seizure threshold.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050482
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  • 5
    Electronic Resource
    Electronic Resource
    CT-ventriculography to control the passage of cerebrospinal fluid (1987)
    Springer
    Acta neurochirurgica 89 (1987), S. 140-143 
    Details
    ISSN: 0942-0940
    Keywords: CSF-pathways ; CSF-passage control ; CT-ventriculography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In conventional ventriculography used to confirm free passage of cerebrospinal fluid (CSF), bony overprojections often makes it difficult to visualize the contrast medium in the cranio-spinal subarachnoid spaces. CT-ventriculography offers an alternative. Because of the high density resolution, even small amounts of contrast material can be seen in the subarachnoid spaces of the cranio-cervical region. Its usefulness is demonstrated in a series of 15 cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01560381
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  • 6
    Electronic Resource
    Electronic Resource
    Ventricle puncture for external CSF drainage and pressure measurement using a modified puncture needle (1988)
    Springer
    Acta neurochirurgica 94 (1988), S. 93-95 
    Details
    ISSN: 0942-0940
    Keywords: External CSF drainage ; CSF pressure measurement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A modified needle for external ventricular drainage is presented. Contrary to conventional spinal needles with this instrument the sharp guide can be withdrawn after penetration of the dura, thus, no sharp instrument affects the brain, nor remains within the ventricles in cases of continuous drainage. Furthermore, depth of penetration can be determined preoperatively by means of a set screw also facilitating fixation of the needle. To date, we have used this modified needle in 50 patients for short or long term CSF drainage and for CSF pressure measurements. Trephination was performed with a hand or battery-driven drill. Except for an infection in one case we found no serious complications in our patients. In our opinion, ventricle puncture for external drainage and pressure measurement with this device is a simple and safe method and can be performed on the ward under local anaesthesia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01406623
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  • 7
    Electronic Resource
    Electronic Resource
    Incidence of wound infection in patients undergoing craniotomy: Influence of type of shaving (1987)
    Springer
    Acta neurochirurgica 86 (1987), S. 79-82 
    Details
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary How the method of shaving affects the incidence of deep postoperative wound infections was examined in 475 patients. It is shown that the rate of infection is not lower after wet shaving than after dry shaving. The overall infection rate was 4.2%, 2.9% in patients who had been shaved wet versus 5.5% in patients shaved dry. The difference is, however, not significant on the 5% level. With respect to dry shaving, the infection rate was not affected by whether the hair was removed with electric clippers alone (2.8%) or whether a disposable razor was also used for additional hair removal in the area of skin incision (3.2%).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01402288
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  • 8
    Electronic Resource
    Electronic Resource
    Closed biopsy of the spine using a stereotactic biopsy forceps (1988)
    Springer
    Acta neurochirurgica 94 (1988), S. 155-157 
    Details
    ISSN: 0942-0940
    Keywords: Closed biopsy ; spine ; stereotactic biopsy forceps
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A new technique for closed biopsy of the spine is presented. Using a stereotactic biopsy forceps, which is advanced to the lesion through a protective puncture cannula, sufficient samples from different sites of the lesion can be obtained. Biopsy was performed in seven patients harbouring osteolytic and osteoplastic lesions of the cervical (3 cases), thoracic (3 cases) and lumbar spine (1 case). Histological diagnosis was possible in five patients. In all of them, metastatic disease was found. In our opinion, using this device closed biopsy of the spine is a simple and efficient method for obtaining sufficient material at different levels of the spine and at different sites within a lesion. We recommend its use when the therapeutic consequences-surgical tumour removal with stabilization, stabilization alone or radiation therapy-is contingent on the histopathological diagnosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01435870
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  • 9
    Electronic Resource
    Electronic Resource
    Subdural and depth electrodes in the presurgical evaluation of epilepsy (1994)
    Springer
    Acta neurochirurgica 128 (1994), S. 84-87 
    Details
    ISSN: 0942-0940
    Keywords: Epilepsy ; epilepsy surgery ; subdural electrode ; dept-electrode
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary From 1987 to 1992, invasive EEG studies using subdural strips, grids or depth electrodes were performed in a total of 160 patients with medically intractable epilepsy, in whom scalp EEG was insufficient to localize the epileptogenic focus. Dependent on the individual requirements, these different electrode types were used alone or in combination. Multiple strip electrodes with 4 to 16 contacts were implanted in 157 cases through burrholes, grids with up to 64 contacts in 15 cases via boneflaps, and intrahippocampal depth electrodes in 36 cases using stereotactic procedures. In every case, localization of the electrodes with respect to brain structures was controlled by CT scan and MRI. Visual and computerized analysis of extra-operative recordings allowed the localization of a resectable epileptogenic focus in 143 patients (89%), who subsequently were referred for surgery, whereas surgery had to be denied to 17 patients (11%). We did not encounter any permanent morbidity or mortality in our series. In our experience, EEG-monitoring with chronically implanted electrodes is a feasible technique which contributes essentially to the exact localization of the epileptogenic focus, since it allows nearly artefact-free recording of the ictal and interictal activity. Moreover, grid electrodes can be used for extra-operative functional topographic mapping of eloquent brain areas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01400656
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  • 10
    Electronic Resource
    Electronic Resource
    Nosocomial Infections in a Neurosurgery Intensive Care Unit (1999)
    Springer
    Acta neurochirurgica 141 (1999), S. 1303-1308 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Intensive care unit; neurosurgery; nosocomial infection; surveillance.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ In order to identify overall and site-specific nosocomial infection (NI) rates in patients receiving neurosurgical intensive care therapy, a prospective study was started in February 1997 in the eight-bed neurosurgical ICU of the University Hospital of Freiburg, Germany. Case records were reviewed twice a week, all microbiology reports were reviewed and ward staff was consulted. NI were defined according to the CDC-criteria and were categorised into specific infection sites. Within 20 months, 545 patients with a total of 5,117 patient days were investigated (mean length of stay: 9.4 days). 113 NI were identified in 90 patients (72 pts. with one, 13 with two and 5 with three infections, respectively). A moderate to high overall incidence (20.7/100 pts.) and a moderate incidence density (22.1/1,000 patient days) of NI in the neurosurgical ICU could be documented; these figures are well within the range of published data. Site specific incidence rates and incidence densities were: 1 bloodstream infection per 100 patients (0.9 central line-associated BSIs per 1,000 central line-days), 9 pneumonias per 100 patients (15.1 ventilator-associated pneumonias per 1,000 ventilator-days), 7.3 urinary tract infections per 100 patients (8.5 urinary catheter-associated UTIs per 1,000 urinary catheter-days). Additionally, 1.1 cases of meningitis, 0.7 brain abscesses/ventriculitis, and 1.7 other infections (surgical site infection, bronchitis, catheter related local infection, diarrhoea) were documented per 100 patients, respectively. 14.6% of isolated pathogens were E. coli, 10.2% enterococci, 9.6% S. aureus, 6.4% CNS, 6.4% Klebsiella spp., 5% Enterobacter spp. and 5% Pseudomonas spp.. In 11 cases of NI no pathogen could be isolated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050434
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