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  • 1
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Bewegungsstörungen ; M. Parkinson ; Stereotaxie ; Tremor ; Hirnstimulation ; Key words Stereotactic surgery ; Parkinson’s disease ; Movement disorders ; Thalamotomy ; Pallidotomy ; Brain ; Stimulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Stereotactic surgery for movement disorders is currently undergoing a re-evaluation. A new understanding of the pathophysiology makes the surgical lesion a logical step for the aleviation of both hyperkinetic symptoms such as tremor and hypokinetic symptoms like bradykinesia. Advances in imaging and electrophysiological control render these procedures more accurate and safer. Indications are medically refractory, Parkinsonean tremor, essential tremor, cerebellar tremor, bradykinesia and L-Dopa induced dyskinesis. The standard procedure is ablative surgery, i.e. thalamotomy for tremors and pallidotomy for bradykinesia, dystonia and L-Dopa induced dyskinesias. Deep brain stimulation is a novel alternative for selected patients which is currently evaluated. Neural transplantation of autologus, fetal or genetically manipulated cell suspensions into the striatum for the time being is experimental.
    Notes: Zusammenfassung Die chirurgische, d.h. stereotaktische Behandlung von Bewegungsstörungen erfährt derzeit eine Neubewertung. Neue Einsichten in die Pathophysiologie der Bewegungsstörungen haben dazu geführt, daß der stereotaktische Eingriff als begründeter therapeutischer Schritt angesehen wird. Die Nebenwirkungen stereotaktischer Eingriffe sind durch neue operative Techniken, digitale Bildgebung und elektrophysiologische Kontrollen geringer geworden. Die hauptsächlichen Indikationen sind Parkinson-Tremor und Rigidität, essentieller Tremor und zerebellärer Tremor. Als etablierte Routinemethode wird die stereotaktische Elektrokoagulation im Thalamus für alle Tremorformen weiterhin bevorzugt. Für die Behandlung von Akinesie und Bradykinesie, besonders auch der Dopa-induzierten Hyperkinesien, gewinnt die Pallidotomie rasch wieder an Bedeutung. Die chronische Stimulation durch Implantation von Hirnelektroden ist in Einzelfällen indiziert. Die Transplantation autologer, fetaler oder gentechnisch manipulierter Zellen wird derzeit in ihrer Bedeutung für die Therapie untersucht.
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Der Nervenarzt 69 (1998), S. 342-351 
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Interhemisphärisches Subduralhämatom ; Falx-Syndrom ; Schädel-Hirn-Trauma ; Subarachnoidalblutung ; Key words Interhemispheric subdural hematoma ; Falx syndrome ; Head injury ; Subarachnoid hemorrhage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The interhemispheric subdural hematoma (ISH) is a special subdural hematoma with regard to both location and symptomatology. The most widely described clinical signs and symptoms associated with an ISH are a lucid interval and the falx syndrome. The latter is featured by a contralateral hemiparesis that is accentuated in the lower extremity but spares the face. Minor head trauma or a preexisting coagulation disorder are also often found. Nonsurgical treatment should be chosen in patients with little neurologic dysfunction and a stable clinical course. Patients with progressive neurologic deterioration and focal neurologic deficits should be operated on without delay. This article provides a review of 99 published cases of ISH and adds 3 cases to the existing literature.
    Notes: Zusammenfassung Das interhämisphärische Subduralhämatom (ISH) nimmt unter den Subduralhämatomen eine Sonderstellung hinsichtlich seiner Lokalisation und Symptomatologie ein. Das Falx-Syndrom, bestehend aus einer kontralateralen, beinbetonten Hemiparese und das symptomfreie Intervall zwischen Unfallzeitpunkt und dem Auftreten klinisch neurologischer Herdsymptome sind hierbei die Hauptmerkmale. Häufig geht einem ISH nur ein Bagatelltrauma voraus, oder es besteht eine Gerinnungsstörung. Die konservative Therapie ist bei geringer neurologischer Symptomatik und klinisch stabilem Verlauf die Therapie der Wahl. Patienten mit progredienter Bewußtseinsstörung und fokal neurologischen Ausfällen sollten umgehend neurochirurgisch versorgt werden. Die bisherige Literatur von 99 Fällen wird zusammengefaßt und um drei eigene Verlaufsbeschreibungen erweitert.
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  • 3
    ISSN: 0942-0940
    Keywords: Keywords: Intracranial neoplasms; intracerebral haematoma; haemorrhagic stroke; computerised tomography; outcome.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ We report about 50 patients with spontaneous intracerebral haematomas (ICH) caused by intracranial neoplasms to assess the underlying histological condition, their presentation on admission, diagnostic work-up, treatment, histological diagnosis, and clinical outcome. These patients were identified in a prospective series of 2041 patients with intracranial neoplasms and 692 patients with spontaneous ICH, which were both consecutively collected over a nine-year-period.  The frequency of ICH in patients with intracranial neoplasms was 2.4%. The frequency of tumour related ICH in the ICH group was 7.2%. The leading cause of tumour related ICH were metastases of extracranial origin (n=18; 36%), followed by glioblastoma multiforme (n=15; 30%). Nine patients (18%) had benign primary intracranial neoplasms. On admission 18 patients were somnolent (36%) and 14 patients (28%) were comatose. In 29 cases (58%) ICH was the first clinical sign of neoplastic disease, while in 21 patients (42%) a malignant tumour was already known. We operated on 45 patients (90%), four patients (8%) were not operated on because of poor clinical condition and died, one patient refused surgical treatment. Six patients (12%) died despite surgery.  This series confirms the importance of a proper neuroradiological and clinical work-up of patients with suspected tumour related ICH followed by operative treatment and histological confirmation of the diagnosis. This is supported by the fact that 18% of patients had prognostically favourable intracranial tumours which would not otherwise have been adequately treated.
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  • 4
    ISSN: 0942-0940
    Keywords: Keywords: MRI; glioblastoma multiforme; metastases.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  Multifocal dissemination of glioblastomas is very rare but is increasing as patients live longer. Between April 1994 and December 1997 one hundred and fifty one patients with a histologically proven glioblastoma multiforme were operated on in the Neurosurgical Department of the University of Kiel, Germany. Recurrent tumours of these patients were removed in 36 patients. Two patients developed multifocal spread of glioblastoma multiforme including spinal drop metastases. Both patients died 10 and 7 months after the primary operation. On histological examination both tumours showed wide perivascular tumour-cell cuffings in the surrounding brain tissue, so that this perivascular growth might be another explanation for the dissemination in these glioblastomas.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Journal of neurology 238 (1991), S. 420-426 
    ISSN: 1432-1459
    Keywords: Spinal cavernoma ; Magnetic resonance imaging ; Arteriovenous malformation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Two contrasting cases of cervical intramedullary cavernous angioma in young female patients are reported. One patient had a 3-year course of step-wise progressive tetraparesis; at each of the five events intramedullary bleeding from a cryptic vascular malformation at C6–7 level was diagnosed by MRI. The other patient presented with one episode which led to MRI diagnosis of a vascular malformation at the C2 level. Both patients eventually underwent complete surgical excision of the angioma with subsequent steady improvement of the neurological deficit.
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  • 6
    ISSN: 1437-2320
    Keywords: Key words Meningioma ; Recurrence ; Elderly
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  With life expectancy in the industrial nations increasing during recent years, the number of patients older than 70 years with intracranial tumours and, especially, meningiomas is rising. To evaluate the indications for operative treatment, we reviewed 66 patients older than 70 years who were operated upon for intracranial meningioma in our department between 1991 and 1997. The mean age was 75 years. The oldest patients were 86 years old. Thirteen patients with recurrent meningiomas were operated upon. The mortality rate was 7.6%. Neurological symptoms improved in 38 patients (57.6%), were unchanged in 11 (16.6%), and deteriorated in 12 (18.2%). Patients with recurrent meningiomas seem to have a higher operative risk and their outcome is worse than after a primary operation. In general, there were good postoperative results in patients with few concomitant diseases, small meningiomas, small edema, short time of operation, and accessible location (convexity rather than skull base). Age in general is not a contraindication for operation. In cases of incidental findings of small meningiomas, we recommend observation and MRI follow-up. Symptomatic meningiomas should be removed whenever there is an acceptable risk from an internal or anaesthesiological point of view.
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  • 7
    ISSN: 1437-2320
    Keywords: Cerebral infarction ; Cerebral ischemia ; Transient ischemic attacks ; Extra-intracranial arterial bypass ; Microvascular surgery ; Somatosensory evoked potentials ; Computed axial tomography ; Hirninfarkt ; Passageres neurologisches Defizit ; Transitorische ischämische Attacke ; Extra-intrakranielle Bypassoperation ; Mikrovaskuläre Chirurgie ; Somatosensorisch evozierte Potentiale ; Computertomographie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Um kurzfristige Veränderungen der Gehirnfunktion zu erfassen, die durch die extra — intrakranielle Bypassoperation bewirkt wurden, untersuchten wir 17 Patienten vor und nach dieser Operation mittels neurophysiologischer und röntgen — computertomographischer Untersuchungsmethoden. Die Computertomographie hilft auf morphologischer Grundlage das Ausmaß des ischämischen Hirnschadens zu bestimmen und ist in einigen Fällen ein wertvolles Hilfsmittel, um vor der Operation die Chancen für eine klinische Befundbesserung abzuschätzen. Die Elektroenzephalographie zeigt bei der Hälfte der Patienten nach einem Hirninfarkt 2 Wochen nach der Operation, daß der ischämische Schaden zugenommen hat (Zunahme eines Herdhinweises), wohl bedingt durch die herabgesetzte intraoperative Hirndurchblutung bzw. den temporären Verschluß der anastomosierten Kortikalarterie. Unter den angewandten neurophysiologischen Untersuchungsmethoden (somatosensorisch evozierte Potentiale, relative und absolute Reizantwortperiode) scheinen die absolute und relative Reizantwortperiode am ehesten geeignet, bei Patienten mit passagerem neurologischem Defizit die spätere Entwicklung abzuschätzen. Hingegen fand sich keine Korrelation zwischen neurophysiologischen Untersuchungsergebnissen und späterem Verlauf der klinischen Symptomatik für die Gruppe der Hirninfarktpatienten (Tab. II).
    Notes: Summary In order to evaluate short-term effects of extra-intracranial arterial bypass procedure (EIAB) on cerebral function, we performed neurophysiological studies, combined with CT-evaluation, on 17 patients undergoing EIAB, pre- and postoperatively. CT helps to define, on a morphological basis, the extent of ischemic brain damage, and is, in some cases, a valuable tool in preoperatively assessing chances for a recovery. EEG shows, 2 weeks after surgery, in 50% of the patients after completed stroke, worsening of ischemic lesions as a result of reduced intraoperative cerebral perfusion and/or temporary occlusion of the recipient cortical vessel. Amongst somatosensory evoked potentials (SEP), and relative and absolute response periods (RPrel/ RPabs), RP abs and RPrel seem to have the highest potential in predicting later outcome in patients with TIA/RIND, while no correlation could be found between neurophysiological data and later clinical course for the completed stroke group (Table II).
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