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  • 1
    ISSN: 0942-0940
    Schlagwort(e): Digital subtraction cisternography ; CT cisternography ; MR cisternography ; CSF fistula
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: 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.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 2
    ISSN: 0942-0940
    Schlagwort(e): Cavernous malformation ; epilepsy ; surgery ; seizure control
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: 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.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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