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  • 1990-1994  (1,064)
  • 1
    ISSN: 0942-0940
    Keywords: Aneurysm rupture ; subarachnoid haemorrhage ; grade IV and V patients ; early aneurysm surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a retrospective study the clinical management of 74 patients with aneurysmal subarachnoid haemorrhage (SAH) admitted in grade IV and V Hunt and Hess was examined. 39 patients (53%) were admitted within 24 hours after SAH, 29 patients (39%) between 24 and 72 hours after SAH, and 6 patients 8%) later than this time interval. The ruptured aneurysms were located at the anterior communicating artery complex in 34 patients (46%), on the middle cerebral artery in 19 patients (26%), on the internal carotid artery in 12 patients (16%) and at the vertebro-basilar artery complex in 9 patients (12%). In 38 patients (51%) no surgical attack on the aneurysm was performed. 19 (50%) of these patients were in grade IV on admission and 19 (50%) in grade V. In 36 patients (49%) the aneurysm was clipped. Of these patients 29 (81%) were in grade IV and 7 (19%) in grade V. Of the 38 patients in whom no aneurysm surgery was done, 37 patients died, representing a mortality rate of 97%, one patient survived in grade III Glasgow Outcome Scale (GOS). Concerning the outcome in those patients with aneurysm clipping, of 19 patients in grade IV operated on early, 10 patients (53%) made a good recovery, 3 (16%) were left severely disabled and 6 patients (31%) remained in a vegetative state or died. Of the 10 patients in grade IV with delayed surgery 4 (40%) were in grade I and II postoperatively, 2 (20%) in grade III, and again 4 (40%) in grade IV and V GOS. None of the 4 patients in Hunt and Hess grade V in whom early surgery was done achieved a good postoperative outcome. 2 patients survived in grade III GOS, and another 2 patients died. Only three patients admitted in grade V survived long enough to be subjected to delayed surgery. Of these patients one survived without deficit, one survived severely disabled and one patient died. From the data presented the following conclusions are drawn: 1. Without surgery the chance of survival in poor-grade aneurysm patients is almost non existent 2. Patients admitted in grade V have a uniformly poor prognosis with a very high mortality whether surgery is done or not, and whether surgery is performed early or late. 3. Patients in grade IV represent a distinct group with a better prognosis than those in grade V, justifying an aggressive surgical management. 4. Early surgery in grade IV patients leads to better results than delayed surgery especially in terms of overall management morbidity and mortality. 5. In order to further improve the results of management of poor-grade aneurysm patients early referral to neurosurgical centres is mandatory.
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  • 2
    ISSN: 0942-0940
    Keywords: Intracranial aneurysm ; operative treatment ; wrapping ; coating ; clipping ; long term results ; rebleeding rate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We report the long term result of the treatment of 29 intracranial ruptured aneurysms by wrapping with or without coating. These patients were followed for a mean period of 11 years. The outcome of all patients was as follows; 19 were categorized as good, 2 were severely disabled, on the Glasgow Outcome Scale (GOS), and 8 died. The rebleeding occurred in 5 patients within 3 years after surgery, and all died. There was an overall rate of 17% of rebleeding in our series, which is much higher than the rebleeding rate after aneurysm treatment by clipping of the neck but lower than the usual rebleeding rate in conservatively treated cases. In conclusion, the wrapping as a choice of treatment of ruptured aneurysms is not a safe alternative to the direct operative occlusion of the aneurysmal sack.
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  • 3
    ISSN: 0942-0940
    Keywords: Ischaemic oculopathy ; venous stasis retinopathy ; neovascular glaucoma ; rubeosis iridis ; STA-MCA anastomosis ; EC-IC bypass surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Effects of STA-MCA anastomosis on two patients with neovascular glaucoma due to occlusion of the internal carotid artery are presented. Both patients improved in visual acuity and central retinal artery pressure as well as in signs of transient ischaemic attack. Postoperative angiography showed a marked decrease in collateral flow through the ophthalmic artery, which is reversed from the normal direction, with the development of blood flow through the anastomosis. Discussion is offered indicating that the lack of collateral flow through both the anterior and posterior communicating arteries is important in addition to occlusion of the internal carotid artery in order to produce full-blown ischaemic oculopathy such as venous stasis retinopathy, neovascular glaucoma or rubeosis iridis. It is stressed that EC-IC bypass surgery should be performed soon after the appearance of ischaemia and before the development of neovascular glaucoma or rubeosis iridis in order to obtain normal vision. In ischaemic oculopathy the results of EC-IC bypass can be evaluated objectively and quantitatively by many noninvasive neuro-ophthalmological tests which are important in discussing the efficacy of the bypass surgery.
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 103 (1990), S. 82-83 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 0942-0940
    Keywords: Medial sphenoid meningioma ; tumour invasion of the cavernous sinus ; recurrence ; radical surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have reviewed the cases of 57 patients with medial sphenoid meningioma who were operated on in our department during the period 1976 to 1988. The patients were grouped according to location, and their pertinent clinical features are presented. Given the frequency of invasion of the cavernous sinus by such tumours, the following question must be considered in each individual case: the potential benefit of the most radical surgery possible, to minimize the recurrence rate, must be weighed against the cost to the patient in diminished quality of life of iatrogenic neurological impairment. We currently advocate the following strategy: radical removal of tumour tissue lying within the cavernous sinus is unwarranted for the first operation if it would entail iatrogenic neurological damage. Only if subsequent follow-up reveals either fast growth of this tissue, or neurological signs and symptoms attributable to it, do we then attempt uncompromising radicality at a second operation.
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  • 6
    ISSN: 0942-0940
    Keywords: Brain injury ; lung contusion ; mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors analysed the results of treatment of 50 head-injured patients who had concomitant chest injuries. The study revealed a high mortality rate (80%) in cases of severe brain injury and acute intracranial haematoma in combination with contusion of lung parenchyma. The prognosis worsens with the severity of the pulmonary injury and is especially bad in cases with a need for ventilatory support. We conclude that new and more effective treatment modalities are necessary to reduce the mortality in these patients.
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 103 (1990), S. 128-130 
    ISSN: 0942-0940
    Keywords: Spasmodic torticollis ; cervical rhizotomy ; myotomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Twenty three patients underwent surgery for spasmodic torticollis. In 11 of the patients myotomy of the sternocleidomastoid muscle was done, and in the remaining 12 patients cervical rhizotomy according to Foerster and Dandy was performed. After a mean follow-up time of 4 years the long term effects of surgery were assessed. Only 2 of the patients (9%) had a good overall outcome in contrast to the poor or very poor results in 13 of the patients (56%). Both of these methods therefore seem to be only rarely indicated for surgical treatment of spasmodic torticollis.
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  • 8
    ISSN: 0942-0940
    Keywords: Animal experiments ; epidural haematoma ; regional cerebral blood flow ; rCBF ; radioactive microsphere technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Regional cerebral blood flow (rCBF) was studied during an aggressive epidural bleed, using a ventilated swine model. rCBF, regional organ blood flow and cardiac output were measured using the radioactive microsphere technique. Blood flows were measured prior to the start of bleeding (Stage 1), when intracranial pressures had reached a plateau and supratentorial perfusion pressure was reduced by about 50% (Stage 2), and at isoelectric EEG (Stage 3). Supratentorial rCBF did not change significantly between stages 1 and 2 while rCVR decreased, implying autoregulatory activity. Cerebral ischaemia developed between stages 2 and 3 when rCBF values fell to levels between 20 and 50% of control values. Infratentorial rCBF changes were similar but less marked, so that adequate brain stem perfusion was maintained below the upper mesencephalon. The left temporal and left parietal cortex and upper mesencephalon suffered a greater reduction in rCBF than other regions, due to proximity to the haematoma and tentorial herniation. The supratentorial pefusion pressure at stage 2 was 60 mm Hg associated with a haematoma volume of 6% of the intracranial volume (ICV). The infratentorial perfusion pressure never fell below 60 mm Hg. The Cushing response was absent when the EEG became isoelectric. This is tentatively ascribed to the absence of hypoxia, because mechanical ventilation was used. Instead systemic arterial hypotension accompanied bleeding in this ventilated model. This hypotension was due to falling cardiac output and peripheral vasodilation.
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  • 9
    ISSN: 0942-0940
    Keywords: Amino acid metabolism ; cerebral glioma ; brain tumour ; 11C-methionine ; PET
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Fourteen patients with cerebral gliomas were studied with positron emission tomography (PET) using L-[methyl-11C]methionine (11C-MET). Positive images of tumour were obtained in all cases regardless of histological grades. The analysis of differential absorption ratio (DAR) showed the higher accumulation of11C-MET in high grade gliomas than in low grade gliomas. PET study with11C-MET will be of great value not only in delineating the location of gliomas, but also in making a qualitative diagnosis from the view point of the biological properties of gliomas.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 104 (1990), S. 21-26 
    ISSN: 0942-0940
    Keywords: ACTH ; basophil proliferation ; ectopic pituitary adenoma ; pituitary adenoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Proliferation of pituitary basophil cells and occasional chromophobe and eosinophil cells into the posterior lobe was found in 61.8±6.9% (α=0.05) in routine necropsy series. The incidence and intensity of proliferation increased in accordance with increasing age. There were no sex differences. The cells were for the most part ACTH-productive; only a few were found to produce somatotropic hormone (STH) or prolactin in exceptional cases, when examined immunocytochemically. Proliferation of these cells appears to take place postnatally, probably in young adult ages. Basophil proliferation, stemming from the pars intermedia, was not related to any clinical features. However, in 6 out of 191 examined cases (3.1±2.5%), the proliferating cells displayed neoplastic potentiality, demonstrated as a combination of mitoses, multinuclear cells, polymorphism, and hypertrophy of the protoplasma in addition to intense proliferation. This finding, described for the first time, may contribute to a better understanding of the origin of silent corticotrophic cell adenomas.
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