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  • 1985-1989  (850)
  • 1965-1969  (282)
  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 100 (1989), S. 3-11 
    ISSN: 0942-0940
    Keywords: Far lateral disc herniation ; extracanalicular disc herniation ; CT-study ; reformation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A retrospective analysis of 45 patients with intra- and extracanalicular lumbar disc herniations (ICDH, ECDH), collected over a 3 year period, is presented. When an intra- or extracanalicular DH was suspected, 1.5 mm axial cuts were made with a GE 9800 from the cranial pedicle through the intervertebral canal to the pedicle of the lower vertebral body. Constructions were then made in coronal and paraxial planes to identify the pathology and its relation to the nerve root. 47% of all ICDH and ECDH were found at the level L4/5, 24% each at the levels L3/4 and L5/S1 respectively and 4% at the level L2/3. In 78% of our patients, the disc fragment was extruded and found well above the level of the disc space, in 22% at the level of the disc space. The coronal reformated views were in general better for demonstrating the course of the compressed nerve root at the levels L2/3–L4/5, while at L5/S1 the paraxial reformated view may yield better images. The distance from the midline of the spinal canal to the medial and lateral edge of the ECDH averages 16.4±3.4 and 33.3±3.6 mm and in some cases the lateral edge was found 39–44 mm from the midline. Pitfalls in the diagnosis of ECDH may be caused by scar tissue, sometimes by an upwardly displaced nerve root or ganglion and, very rarely, by a neurinoma. Pitfalls in therapy, i.g. false negative intraspinal exploration in cases of intraor extracanalicular disc herniations or exploration of the wrong intervertebral canal, may result due to insufficient neuroradiological analysis or from insufficient consideration of the anatomical situation by the neurosurgeon.
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  • 2
    ISSN: 0942-0940
    Keywords: Subarachnoid haemorrhage ; plasma renin activity ; sympathetic nervous system ; brainstem dysfunction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The possible relationship between plasma renin activity and neurological deficits was examined in ten patients with spontaneous subarachnoid haemorrhage in a prospective clinical study. The patients were examined daily, particular attention being given to signs of brain stem dysfunction. The degree of impaired consciousness was assessed using the Glasgow Coma Score. Plasma renin activity was determined on days 1–5, 7, 9, 11, 13, 15 and 21 after the initial bleeding episode using an Angiotensin-I-radioimmunoassay. Six of seven patients with signs of brain stem dysfunction displayed a marked increase in plasma renin activity. Thus a significant negative correlation between the degree of consciousness and the plasma renin activity resulted. An explanation for this correlation may be found in the localization of the autonomous centres and the high concentrations of renin in the hypothalamus and brain stem. The individual changes in plasma renin activity have prognostic significance, whereas single estimated plasma renin activities show great interindividual differences and have only limited prognostic value.
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  • 3
    ISSN: 0942-0940
    Keywords: Brain contusion ; contusion volume ; quantitative assessment, CT ; CSF-CKBB clearance ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In order to evaluate if it is practically possible to assess the volume of contused brain tissue from the CT pictures, a comparison has been carried out between the size of the cerebral contusion(s)-as estimated from the CT scans-and the post-traumatic CSF-CKBB activity, in a series of 29 patients with severe head injury. A clearance curve for the elimination of CKBB from the CSF was constructed. The relation between contusion volume and CSF-CKBB-activity was not statistically significant, while the relationships between contusion volume and outcome, and between CSF-CKBB, as estimated at 6 hours after trauma from the clearance curve, and outcome, were.
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  • 4
    ISSN: 0942-0940
    Keywords: Experimental subarachnoid haemorrhage ; 6-hydroxydopamine ; denervation ; ultrastructure of cerebral vessels
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Transmission electron microscopy of the middle cerebral artery from cats exposed to subarachnoid injection of blood 3 and 7 days before, showed several damage of the vascular ultrastructure. The intima was thickened with swelling and vacuolization of endothelial cells, with a plump appearance and disruption of tight junctions. The cellular surface was corrugated and the subendothelial space contained proliferating and vacuolated smooth muscle cells capped by elastin and collagen fibres. The internal elastic lamina was also corrugated and disrupted. The adventitial changes were axonic cytoplasmic and mitochondrial swelling, virtual absence of synaptic vesicles, and disruption of the outer axonal membrane, suggesting denervation of cerebral vessels. With administration of 6-hydroxydopamine (6-OHDA), similar ultrastructural changes were observed in the adventitia. These observations indicate that denervation induced by subarachnoid bleeding could be involved in the pathophysiology of cerebrovascular spasm. Subarachnoid haemorrhage, but not 6-OHDA, affects also intima and tunica media, suggesting other mechanisms, in addition to denervation, can participate in the vasospasm.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 101 (1989), S. 1-2 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 101 (1989), S. 18-22 
    ISSN: 0942-0940
    Keywords: Aneurysms ; delayed referral ; vasospasm ; recurrent haemorrhage ; temporary clip
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This is a retrospective study of 100 cases of intracranial aneurysms, treated in an Indian hospital, reflecting the special situation and experiences in our country. The incidence of subarachnoid haemorrhage due to ruptured aneurysm has been more or less the same as is reported from other parts of the world. The cases of recurrent haemorrhage resulting in poor clinical status are more common in our situation. Delayed referral and diagnosis were responsible for recurrent haemorrhage, increased morbidity and mortality. Forty two percent developed cerebral vasospasm within two weeks after the bleed. The use of a temporary clip on the parent vessel prevented the intraoperative rupture of the aneurysm while dissecting round about the aneurysm. Operative mortality was eight percent in the present series.
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  • 7
    ISSN: 0942-0940
    Keywords: Subarachnoid haemorrhage ; computerized tomography ; cerebral angiography ; brain ischaemia ; vasospasm ; hydrocephalus ; unknown aetiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors review the literature on subarachnoid haemorrhage of unknown aetiology (SAHUE) and analyze a personal series of 212 patients diagnosed as SAHUE. These patients represent 30% of all cases of primary SAH admitted over a 14.5 year period. The age, sex, antecedents and initial clinical presentation of patients with SAHUE were indistinguishable from those of patients with subarachnoid haemorrhage due to ruptured aneurysm (SAHRA). However, the present series of SAHUE compare favourably with both a personal and a previously reported series of SAHRA insofar as clinical grade on admission (94% of patients in grades I–II of Botterell), presence of blood on CT (51%), vasospasm (5%), ischaemic deficits (3.3%), persistent hydrocephalus (3.5%), rebleeding (6%) and fatal result (3.9%) are concerned. The amount of blood on CT scan in our patients with SAHUE was associated with a significantly higher incidence of brain ischaemia and hydrocephalus but did not correlate with the Botterell grade on admission or final outcome, which were good in the majority of cases regardless of the presence or not of visible cisternal haemorrhage. The results of the present series confirm that the final prognosis of patients with primary SAH showing normal four-vessel cerebral angiography is essentially favourable.
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  • 8
    ISSN: 0942-0940
    Keywords: Carotid endarterectomy ; extracranial to intracranial by-pass ; temporary shunt ; carotid artery occlusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 23 patients with unilateral internal carotid artery stenosis (〉70%) and contralateral internal carotid artery occlusion in the neck are reported. The symptoms are referable to the side of the occlusion in 13 cases (57%), to the side of stenosis in 7 cases (30%) and non-localizing in 3 cases (13%). All 23 patients had a carotid endarterectomy performed on the side of the stenotic lesion. There was no operative mortality. Late neurological symptomatology after surgery was referable to the side of stenosis in 13% and to the side of occlusion in 9%. The authors consider that, in cases of significant stenosis (greater than 70%) of an internal carotid artery with a contralateral occlusion, preference should always be given to endarterectomy of the stenotic side, reserving extra-intracranial by-pass of the occluded side for patients who remain symptomatic after endarterectomy of the stenotic side.
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  • 9
    ISSN: 0942-0940
    Keywords: Diffuse axonal injury ; head injury ; neuropathology ; intracranial haematoma ; coma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Diffuse Axonal Injury (DAI) is a well known entity that affects many patients with severe head trauma. Classically DAI has been considered the pathological substrate of those cases rendered unconscious at the moment of impact and in which the CT scan does not show mass lesions. Diffuse axonal damage is almost always related to mechanisms of injury in which the rotational acceleration produces shear and tensile strains of high magnitude. In this paper we present a group of 24 patients with a severe head injury in whom the postmortem examination demonstrated unequivocal signs of DAI. Widespread axonal retraction balls, located preferentially in the centrum semiovale and internal capsule were the most constant histological finding. We divided the entire series into two subgroups. One group (15 cases), included all the patients in whom the CT scan did not demonstrate mass lesions. In the second group (9 patients) we considered patients with a diffuse axonal injury in whom the CT scan additionally demonstrated a mass lesion (6 acute subdural haematomas, 2 intracerebral and 1 extradural haematoma). The mean age of the entire group was 26 years. Twenty two patients were injured in a road traffic accident, the remaining two fell from a considerable height. All were rendered immediately unconscious on impact. Diffuse brain damage is a common finding in patients with a severe head injury and immediate coma in whom the CT scan does not show mass lesions. Diffuse axonal injury can also appear in connection with a wide spectrum of focal lesions (acute subdural haematoma, basal ganglia haematoma etc.). Associated shear injuries of the brain in this latter group, could justify the poor outcome that certain groups of patients had in spite of the rapid surgical treatment and aggressive control of intracranial pressure.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 13 (1965), S. 249-256 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Experiences with theTurbobit-Craniotome in the Göttinger neurosurgical department are described. To date more than 100 osteoplastic craniotomies have been performed with this new apparatus. During this trial period theTurbobit has not been used for trepanation of the posterior skull fossa because of the varying thickness of the bone in the posterior fossa. The supratentorial craniotomies were performed for various diseases and injuries. The advantages of the newCraniotome are described in detail. The extreme speed with which an osteoplastic operation may be performed, the reliability of the apparatus, and the reduced danger of haemorrhage from the diploic vessels due to the high-speedCraniotome are specially stressed. TheTurbobit-Craniotome does not appear to have any significant disadvantages. The possible complications and dangers resulting from use of theTurbobit—which in part could be ascribed to an initial lack of experience in using the apparatus—are alluded to and, at the same time, suggestions are put forward as to how they may be minimized.
    Abstract: Résumé L'utilisation du crâniotomeTurbobit—au département neurochirurgical de Göttingen. Plus de 100 crâniotomies ont été réalisées avec ce nouvel appareil. Pendant cette période d'essai, leTurbobit n'a pas été utilisé pour la trépanation de la fosse postérieure à cause de l'épaisseur variable de l'os dans cette région. Les crâniotomies supratentorielles ont été pratiquées pour diverses affections et traumatismes. Les avantages du nouveau crâniotome sont décrits en détail. L'auteur souligne la maniabilité de l'appareil, la diminution du danger d'hémorragie diploïque grâce à la grande rapidité mise par leTurbobit à réaliser une crâniotomie. LeTurbobit ne semble pas présenter d'inconvénients majeurs. Les complications et les dangers résultant de l'utilisation duTurbobit (liés essentiellement au manque d'expérience de l'utilisateur) ont été mentionnés, en même temps qu'ont été proposées des solutions pour les diminuer.
    Notes: Zusammenfassung Es wird über die Erfahrung mit demTurbobit-Craniotom in der Göttinger Neurochirurgie berichtet. Insgesamt wurden bisher mehr als 100 osteoplastische Craniotomien mit dem neuen Gerät durchgeführt. Trepanationen der hinteren Schädelgrube sind während der Erprobungszeit wegen der unterschiedlichen Knochendicke der Hinterhauptsschuppe mit demTurbobit noch nicht vorgenommen worden. Die Craniotomien über den Großhirnhemisphären erfolgten wegen verschiedener Erkrankungen und Verletzungen. Die Vorteile des neuenCraniotoms werden ausführlich besprochen. Insbesondere sind die große Schnelligkeit, mit welcher osteoplastische Trepanationen durchgeführt werden können, die relativ sichere Arbeitsweise des Gerätes und die verminderte Blutungsgefahr aus den Diploegefäßen bei Verwendung des hochtourig laufendenCraniotoms hervorzuheben. Wesentliche Nachteile weist dasTurbobit-Craniotom nicht auf. Auf mögliche Komplikationen und Gefahren bei Verwendung desTurbobit — die zum Teil auf eine anfänglich noch mangelnde Erfahrung im Umgang mit dem Gerät zurückzuführen sind — wird hingewiesen und gleichzeitig mitgeteilt, wie diese zu vermeiden sind.
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