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  • 1
    Keywords: brain ; Germany ; CT ; FOLLOW-UP ; imaging ; QUANTIFICATION ; TOOL ; SURGERY ; TIME ; PATIENT ; magnetic resonance imaging ; HUMANS ; REGION ; HIGH-RISK ; sensitivity ; specificity ; pathology ; physiology ; ADULT ; SUBSET ; methods ; Moyamoya disease ; female ; Male ; Middle Aged ; radiography ; Image Processing,Computer-Assisted ; carotid stenosis ; PROBABILITY ; ROC CURVE ; Tomography,x-ray computed ; A ; Cerebral Revascularization ; Cerebrovascular Circulation ; Cerebrovascular Disorders ; Constriction,Pathologic ; Middle Cerebral Artery
    Abstract: In order to identify patients who suffer from hemodynamic cerebral insufficiency and can benefit from cerebral revascularization procedures, xenon-CT scanning has been established to reliably measure the critical cerebrovascular reserve capacity. As a need for alternative quantification methods arises, this study aims to characterize the significance of both time-to-peak (TTP) and mean transit time (MTT) in perfusion-weighted imaging (PWI) in this particular subset of patients. Ten patients in routine preoperative work-up for cerebral revascularization were prospectively enrolled and underwent both XeCT scanning and PWI. Cerebrovascular reserve capacity (CVRC) was calculated for each region of interest (ROI, n = 504) after administration of a vasoactive stimulus. ROIs were anatomically matched with those of PWI after TTP and MTT were calculated. Highly significant negative correlation was found for TTP and CVRC for all ROIs (r = -0.3954, p 〈 0.0001; symptomatic ROIs: r = -0.4867, p 〈 0.0001). Correlation was weak for MTT and CVCR (r = -0.1287; p 〈 0.01). The optimum threshold for TTP to detect impaired cerebrovascular reactivity in our patient group was 4 s (specificity 90.8%, sensitivity 44.4%) for all ROIs (TTP 〉 4.4 s for symptomatic ROIs, specificity 88.4%, sensitivity 62.7%). An approximative equation to calculate the probability of pathological findings could be derived from the data. The positive predictive value (PPV) was 0.76 (symptomatic 0.78) with a negative predictive value (NPV) of 0.71 (symptomatic 0.78). While PWI currently is not able to replace XeCT in the direct quantification of CVRC, it may serve as a readily available follow-up tool. A TTP threshold of greater than 4 s allows to confirm a cerebrovascular compromise in a selected high-risk subgroup of patients
    Type of Publication: Journal article published
    PubMed ID: 18791753
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  • 2
    Keywords: DISEASE ; RISK ; ASSOCIATION ; LESIONS ; CHILDREN ; PATHOPHYSIOLOGY ; MOVEMENTS ; REMOVAL ; Cerebellar mutism ; Dysplastic cerebellar gangliocytoma ; DYSPLASTIC GANGLIOCYTOMA ; Lhermitte-Duclos disease ; Posterior fossa ; POSTERIOR-FOSSA SURGERY ; SUBSEQUENT DYSARTHRIA ; TRANSIENT MUTISM ; VERMIAN MEDULLOBLASTOMA
    Abstract: Cerebellar mutism (CM) is a rare and severe form of speech and language impairment, mostly diagnosed in children and adolescents and rarely reported in adults. We here review the literature and summarize all anatomical structures related to the pathogenesis of this rare syndrome. We also report two illustrative cases of CM following surgical treatment of Lhermitte-Duclos disease (LDD; dysplastic gangliocytoma) in two adult patients. LDD is a rare benign cerebellar tumor. Surgical excision appears to be the only effective treatment. However, surgery is hampered by the difficulty to distinguish between tumor and healthy cerebellar tissue, which may result in extensive resection and cause neurological deficits such as CM. A review of the literature and our two cases suggest that lesions or functional impairment of paravermian structures including dentate nuclei, vermis, lateral hemispheres, and cerebellocortical pathways contribute to the development of CM. However, there is no single anatomical structure identified to be associated with CM. It is unknown whether some diseases such as LDD carry a higher risk of postoperative CM than others. As illustrated by our two cases, although there are no special means, optimal preoperative diagnosis might contribute to the prevention of this syndrome. Despite the severity, CM carries a favorable prognosis and generally resolves within a few months. To conclude, we review the clinical signs and particularly the pathophysiological observations and anatomical structures affected in the development of postoperative CM and contribute two cases illustrating the pathogenesis, prognosis, and possible prevention of this syndrome, to focus that CM might also occur in adults even in association with rare tumors
    Type of Publication: Journal article published
    PubMed ID: 20668902
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Neurosurgical review 1 (1978), S. 3-4 
    ISSN: 1437-2320
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Neurosurgical review 1 (1978), S. 5-13 
    ISSN: 1437-2320
    Keywords: Pituitary adenoma ; Microsurgery ; Neuroendocrinology ; Computerized tomography ; Hypophysenadenom ; Mikrochirurgie ; Neuroendokrinologie ; Computer-Tomographie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Fortschritte in der Hypophysenchirurgie basieren auf der mikrochirurgischen Technik, der endokrinologischen Funktionsdiagnostik sowie der Computer-Tomographie. Das mikrochirurgische Vorgehen hat den transsphenoidalen Zugang mit selektiver Adenomektomie ermöglicht. Darüber hinaus empfiehlt sich dieser Operationsweg auch bei symmetrisch suprasellär aus der Sella herausgewachsenen Geschwülsten. Endokrinologisch lassen sich mit Hilfe der Funktionsdiagnostik Hypophysen-Insuffizienzen und Hormon-Exzesse, die alle Vorderlappenhormone betreffen können, exakt bestimmen; als inaktiv gelten heute nur noch etwa 30% der Adenome. Von diesen Ergebnissen hängt die Indikation zur Operation, die Art und das Ausmaß des operativen Eingriffs ab. Darüber hinaus läßt sich der Operationserfolg endokrinologisch kontrollieren; auf diese Weise ist z. B. in der Behandlung der Akromegalie eine Normalisierung des GH-Exzesses bei 90% der intrasellären Adenome erreicht worden. Die selektive Adenomektomie hat auch die Behandlung des hypothalamisch/hypophysären Cushing-Syndroms bereichert und bei Frauen mit hyperprolaktinämischer Amenorrhoe und Kinderwunsch die Wiedererlangung ovarieller Zyklen und Schwangerschaften ermöglicht. Für die Prolaktinome zeichnet sich erstmals eine erfolgversprechende medikamentöse Therapie der Hypophysenadenome ab. Zur Lokalisation und Bestimmung der Ausdehnung der Geschwülste ist die Computer-Tomographie die entscheidende Untersuchung, welche die Wahl des operativen Zugangs (transsphenoidal, transkranial) bestimmt und postoperativ die Radikalität des Eingriffs belegt und im Falle verbliebener Tumorreste zu einer zweiten Operation, u. U. auf dem anderen Operationsweg, Anlaß geben kann.
    Notes: Summary Progress in pituitary surgery has arisen with the introduction of microsurgical technique, endocrinological functional tests and computerized tomography of the skull. Using such microsurgical procedures, the transsphenoidal approach to the sella with selective adenomectomy is rendered possible. Furthermore, this operative approach is recommended also for pituitary tumours growing symmetrically to the suprasellar region. Endocrinological functional tests permit exact measurement of pituitary insufficiency and hormonal excesses, including all hormones of the anterior pituitary; today, only 30% of the adenomas are regarded as hormonally inactive. The indication to operate, the approach and the extent of the operative procedures depend on these results. Further, the operative result can be controlled by endocrine tests; in this way treatment of acromegaly can be improved: in patients with intrasellar adenomas GH-excess can be normalized in 90% of the patients. Selective adenomectomy has also improved the treatment of Cushing's disease. In women with hyperprolactinemic amenorrhea, who wished to have children, ovarian cycles and pregnancy occurred. In the case of prolactinomas, for the first time medical treatment of pituitary adenomas has been successful. Computerized tomography of the skull is the most important examination in order to localize a tumour and to determine its extent whereby the operative procedure (transsphenoidal, transcranial) is decided. After operation, the radicality of the operation can thus be documented and in the case of tumour residuals a second operation may then be indicated.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Neurosurgical review 1 (1978), S. 47-67 
    ISSN: 1437-2320
    Keywords: Cervical Spine ; Lateral operations ; Lateral extraspinal disc extrusions ; Lateral section joint facets ; Posterior cervical hemicorporectomy ; Cervical corporectomy ; Cervical vertebrectomy ; Halswirbelsäule ; laterale Operationen ; laterale extraspinale Bandscheibenvorfälle ; laterale Operation an den Gelenkflächen ; hintere cervicale Hemicorporectomie ; cervicale Corporectomie ; cervicale Vertebrectomie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bericht über neue Entwicklungen in der Technik der Operationen an der Halswirbelsäule von lateral her. Ein vorderer Zugang zur Halswirbelsäule bei der Operation kann immer noch als die Methode der Wahl gelten, wenn traumatische Deformierungen der Wirbelsäule chirurgisch angegangen werden sollen mit Ausnahme einer einseitigen Luxation der Gelenkfortsätze, die nicht reduzierbar ist sowie von primären paraspinalen traumatischen Bandscheibenvorfällen, die die Rami anteriores der Spinalnerven und die A. vertebralis komprimieren. Schließlich muß als Ausnahme auch die totale Entfernung eines Wirbelkörpers gelten. Für die letzte kann eine Kombination der Operation von vorne und seitlich her erreicht werden, indem man den gleichen anterolateralen Zugang wählt. Mit dieser neuen Entwicklung können alle traumatischen Läsionen der Halswirbelsäule vom vorderen und/oder lateralen Zugang her operiert werden. Cervikale Bandscheibenvorfälle oder Spondylosis werden heute einheitlich von lateral her operiert. Mediale Osteophyten und Bandscheibenvorfälle werden von einem lateralen durch den Diskusraum gehenden Zugang unter direkter Sicht und in einer Ebene parallel zur duralen Theca entfernt. Fusionen zweier Wirbelkörper werden mit Hilfe eines kortikalen Knochenspanes von einem lateralen Zugang her in den inzwischen ausgeleerten Zwischenwirbelspalt vorgenommen. Spinale Symptome, die durch einen Zug am Rückenmark infolge einer ankylosierenden Kyphose hervorgerufen werden, behandelt man durch eine Hemicorporectomie des posterioren Anteils, und dies von einem lateralen Zugang. Als neue Einheiten werden primäre und sekundäre paraspinale Bandscheibenextrusionen beschrieben sowie die Knickbildungen an den Rami anteriores der cervicobrachialen Plexus, die über die lateralen Enden der Processus transversi entstehen, weil eine Dislokation nach vorwärts oder eine Deformität im Sinne einer Kyphose an den cervicalen Wirbeln besteht. Laterale Operationen werden auch für die Wiederherstellung von Läsionen des Plexus brachialis sowie für Prozesse, die auf die A. vertebralis einwirken und schließlich für Sanduhrtumoren angewandt. Bei Knochentumoren der cervicalen Halswirbelsäule können die Corpora der Wirbel entfernt und durch Knochenplastik ersetzt werden, wobei der Zugang kombiniert von vorne und lateral ist. Eine komplette Vertebrectomie im Halsgebiet wurde in 2 Fällen durch kombinierten Zugang von vorne, lateral und hinten ausgeführt. In allen Fällen einer kompletten Entfernung des Wirbelkörpers kann gleichzeitig eine zusätzliche Operation von hinten ausgeführt werden, um die Halswirbelsäule zu stabilisieren. Das kann sowohl durch Fusion wie durch Verdrahtung erreicht werden.
    Notes: Summary New developments in the techniques of lateral operations upon the cervical spine are described; anterior operations are still considered the method of choice in the surgical treatment of traumatic deformities of the spine with the exception of irreducible unilateral locking of articular processes, traumatic primary paraspinal disc extrusions compressing the anterior rami of the spinal nerves and the vertebral artery, and total vertebral corporectomy. The latter is achieved by a combined anterior and lateral operation using the same anterolateral approach. With this new development all surgical traumatic lesions of the cervical spine can be treated by means of anterior and/or lateral operations. Cervical disc extrusions and spondylosis are now invariably treated by lateral operations. Medial osteophytes and disc extrusions are removed by means of a lateral trans-disc space approach under direct vision of, and in a plane parallel to the dural theca. Interbody fusion is performed by inserting a cortical bone graft via the lateral opening into the emptied disc space. Spinal cord deficit caused by traction on the cord produced by ankylosing kyphosis is treated by posterior hemicorporectomy using of a lateral approach. New entities described are primary and secondary paraspinal disc extrusions and kinking of the anterior rami of the cervical or brachial plexuses by the lateral ends of the transverse processes in the presence of anterior dislocation or kyphotic deformity of the cervical vertebrae. Lateral operations are also applied for the repair of brachial plexus lesions, involvement of the vertebral artery and dumb-bell tumors. In tumors of the cervical vertebral bones removal of vertebral bodies and their replacement by grafts can be performed by combined anterior and lateral operations. Complete cervical vertebrectomy has been performed in 2 cases by means of combined anterior, lateral and posterior operations. In all cases of complete removal of a vertebral body an associated posterior operation may be applied for stabilization of the cervical spine by means of fusion or wiring.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Neurosurgical review 1 (1978), S. 123-131 
    ISSN: 1437-2320
    Keywords: Experimental CNS-tumors ; Transplantation ; Resorptive carcinogens ; Chemotherapy ; Experimentelle Tumoren des ZNS ; Transplantation ; Resorptiv Carcinogene ; Chemotherapie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Sechs Tumoren des zentralen Nervensystems, die mit resorptiv wirkenden Carcinogenen erzeugt worden waren, wurden transplantiert. Gliome und Ependymome des zentralen Nervensystems wurden serienmäßig intracerebral bei isologen BD-IX-Ratten verimpft. Alle Tumoren wurden über 22 Passagen und mehr verfolgt. Die histologischen Eigenschaften, die Vorzugslokalisation und die Veränderung während der beobachteten Passagen wurden beschrieben. Bei den Tumoren des zentralen Nervensystems konnten drei Wachstumsperioden unterschieden werden: Der ursprüngliche Tumor und die unmittelbar folgenden (1–3) Passagen waren ähnlich; in den weiteren Passagen trat eine starke Variabilität im histologischen Bild auf. In den späteren Generationen, etwa von der 10. Passage an, waren diese Tumoren niederdifferenzierte Gliome. Diese Morphologie blieb für die noch folgenden Generationen unverändert. Diese Entwicklung trat bei fünf Linien in sehr ähnlicher Art auf, eine Linie bewahrte die hochdifferenzierte Morphologie des Oligodendrogliomes über den bis jetzt beobachteten Zeitraum. Die Bedeutung dieses Modells für chemotherapeutische und zytogenetische Studien wird diskutiert.
    Notes: Summary Six tumors of the central nervous system induced with resorptive carcinogens were transplanted. Gliomas and ependymomas of the central nervous system were grafted serially into the brain of isologous BD-IX-rats. All tumors were followed over 22 passages on the average. Histological properties, preferential location and the alterations taking place during the observed generations were reported. In the tumors of the central nervous system, one could distinguish three periods of growth: the original tumors and the immediately following (1–3) passages were similar; in the subsequent passages, a high variability in the histologic patterns was noted. The morphology of low differentiated gliomas was found in the later generations approximately from the 10th on and then persisted unchanged. This development was found in five lines almost identically; one line preserved the high differentiated morphology of oligodendroglioma over a long period. The use of this model for both chemotherapeutical studies and cytogenetic considerations is discussed.
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Neurosurgical review 10 (1987), S. 6-6 
    ISSN: 1437-2320
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 8
    ISSN: 1437-2320
    Keywords: Caudate nucleus ; dopamine receptors ; haloperidol ; neuroreceptors ; positron emission tomography (PET) ; schizophrenia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The radioligand 3-N-[11C]methylspiperone (11C-NMSP) binds to D2 dopamine receptors with high affinity. We determined the rate of binding in 12 male volunteers, using a 3-compartment model to relate the time integral of the tracer plasma concentration to the distribution of the tracer in the caudate nucleus measured by positron tomography. The rate of binding (k3) was defined as the product of the bimolecular association rate (kon) and the quantity of available receptors (B'max). We calculated the product as the ratio between the steady-state rate of accumulation and the volume of distribution in the caudate nucleus. The average value was 0.100 min−1 in the normal volunteers. We varied k3 by reducing the number of available receptors with the D2 dopamine receptor blocking agent haloperidol ingested 4 hours before the tracer injection. In the normal volunteers, we calculated a receptor density of 17 pmol g−1 in the caudate nucleus and an inhibitory constant of haloperidol of 3 nM by comparing tracer accumulation in the absence and presence of the blocking agent. Bmax was also calculated in older men, drug-naive schizophrenics, and drugtreated schizophrenics (all men). The lowest value of Bmax was calculated in the older men (6 pmol g−1); the highest in the two groups of schizophrenic patients (39 and 41 pmol g−1, respectively).
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  • 9
    ISSN: 1437-2320
    Keywords: Glioblastoma ; positron emission tomography (PET) ; regional cerebral blood flow ; single photon emission computer tomography (SPECT)
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract 99mTc-hexamethyl-propyleneamine-oxime (HM-PAO) was developed as a radiotracer of regional cerebral blood flow (rCBF) with SPECT. THe purpose of this study was to investigate if HM-PAO is able to trace rCBF in primary brain tumors. In 10 patients with glioblastoma grade IV the intracerebral distribution of HM-PAO was studied in comparison with C15O2 steady state inhalation technique and PET for rCBF evaluation. In all instances the cerebral HMPAO distribution was comparable with rCBF pattern as confirmed by a significant correlation of tumor to cortex ratios. The results indicate the clinical usefulness of HMPAO for tracing rCBF in brain tumors.
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  • 10
    ISSN: 1437-2320
    Keywords: Collet-Sicard syndrome ; hypoglossal nerve ; jugular foramen ; neurinoma ; Vernet's paralysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Neurinomas in the region of the jugular foramen are extremely rare, are difficult to diagnose before surgery, and have seldom been described in the literature. The typical jugular foramen syndromes (Collet-Sicard syndrome, Vernet's paralysis) may be caused by many various disorders. The diagnostic problems are illustrated using one of our cases as an example. The differential diagnosis was made before surgery using currently available radiologic techniques. The tentative diagnosis “neurinoma of the hypoglossal nerve” was confirmed intraoperatively and histologically.
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