Zentralblatt Fur Neurochirurgie最新文献

{"title":"Antibiotic prophylaxis in cerebrospinal fluid shunting: reassessment of Cefotiam penetration into human CSF.","authors":"M Knoop,&nbsp;M Schütze,&nbsp;J Piek,&nbsp;B Drewelow,&nbsp;R Mundkowski","doi":"10.1055/s-2007-968168","DOIUrl":"https://doi.org/10.1055/s-2007-968168","url":null,"abstract":"<p><strong>Objects: </strong>Shunt infection is a major complication of shunt implantation. Numerous clinical studies give evidence that antibiotic prophylaxis is efficacious in preventing infections after cerebrospinal fluid shunting. In CSF shunting, antibiotics need to reach sufficient concentrations not only in the blood shielding the operative field but also in tissues and the CSF compartment. Cefotiam is widely used for prophylaxis in neurosurgery. Some clinical trials report that this beta-lactam is able to penetrate considerably into the CSF. However, these studies include disease patterns which are most likely to be associated with a pathological permeability of the blood-brain barrier. Therefore, this study was designed to investigate the extent of penetration of Cefotiam into human CSF in patients without morphological disruption of the blood-brain barrier.</p><p><strong>Methods: </strong>The penetration of Cefotiam into human CSF was investigated in 23 patients without morphological disruption of the blood-brain barrier undergoing CSF shunt surgery. 2 g Cefotiam was administered prior to surgery as a short-term infusion for a period of 15 min. Samples of blood and CSF were collected intraoperatively. The concentrations of Cefotiam were determined by bioassay.</p><p><strong>Results: </strong>All patients (n=23) showed moderate to high plasma levels of Cefotiam (range: 19.8-146.2 mg/L); the pharmacokinetic profiles in blood accorded well with published data. In contrast to earlier studies, no Cefotiam was detected in CSF.</p><p><strong>Conclusion: </strong>This study clearly demonstrates that Cefotiam does not penetrate through an intact blood-brain barrier into human CSF. Although Cefotiam has been shown to be valuable for the perioperative prophylaxis of shunt infection, other antibiotics might be superior if they are capable of entering the CSF. Further studies are required to address this assumption.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"68 1","pages":"14-8"},"PeriodicalIF":0.0,"publicationDate":"2007-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2007-968168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26711056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PMMA versus titanium cage after anterior cervical discectomy - a prospective randomized trial.","authors":"J Schröder,&nbsp;F Grosse-Dresselhaus,&nbsp;C Schul,&nbsp;H Wassmann","doi":"10.1055/s-2006-942184","DOIUrl":"https://doi.org/10.1055/s-2006-942184","url":null,"abstract":"<p><strong>Introduction: </strong>Nonautologous interbody fusion materials are utilised in increasing numbers after anterior cervical disc surgery to overcome the problem of donor site morbidity of autologous bone grafts. This study investigates the performance of two nonautologous materials, the bone cement Polymethylmethacrylate (PMMA) and titanium cages. This prospective randomised trial, with assessment of the results by an independent observer, evaluates whether a Polymethylmethacrylate (PMMA) spacer or a titanium cage provides a better fusion rate around the implant and a better clinical outcome.</p><p><strong>Patients/material and methods: </strong>Between 2000 and 2002, 115 patients with monoradicular cervical nerve root compression syndrome caused by soft cervical disc herniation were eligible for this study. Myelopathy, excessive osteophyte formation, and adjacent level degeneration were exclusion criteria. A block-restricted randomisation was applied. The 2-year clinical outcome served as the primary endpoint of the study. Clinical outcome was assessed according to the Odom scale by an independent observer at the follow-up examination. Preoperative, postoperative, and follow-up radiographs were taken.</p><p><strong>Results: </strong>The study was completed by 107 patients (53 with PMMA and 54 with titanium cage). No significant difference between the two groups could be established with respect to the clinical outcome. In each group, 26 patients scored excellent. Good results were found in 19 PMMA patients and 16 titanium cage patients; satisfactory results were found in 8 PMMA patients and 9 titanium cage patients; bad results were found in 3 titanium cage patients. In 47 titanium cage cases (87%), fusion occurred radiologically as bony bridging around the implant. The fusion rate was significantly lower (p=0.011) in the PMMA group, with 35 cases (66%) united at follow-up.</p><p><strong>Conclusion: </strong>The radiological result of the titanium cage is superior to that of PMMA with respect to the fusion rate. Although the titanium cage achieves a better fusion rate, there is no difference between titanium cages and PMMA with respect to the clinical outcome.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"68 1","pages":"2-7"},"PeriodicalIF":0.0,"publicationDate":"2007-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26251230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occult intrasacral meningocele: case report and review of the literature.","authors":"M Turgut,&nbsp;O Akyüz,&nbsp;A Unsal","doi":"10.1055/s-2007-968169","DOIUrl":"https://doi.org/10.1055/s-2007-968169","url":null,"abstract":"<p><p>Occult intrasacral meningocele, characterised by the presence of a cyst within the sacral spinal canal, is an unusual congenital lesion. A 26-year-old female presented with a history of low back pain and sensory disturbance in the lower extremities, and urinary incontinence. CT scan of the sacral region showed an asymmetrical widening of the sacral canal and the existence of a thinned bone contour. Magnetic resonance (MR) imaging revealed an intrasacral mass as a low signal intensity area on the T1-weighted image and a high signal intensity area on the T2-weighted image, suggesting a cyst containing cerebrospinal fluid (CSF). The patient underwent sacral laminectomy and posterior exploration showed the presence of sacral erosion and an intrasacral cyst containing CSF devoid of neural contents. Partial surgical excision of the cyst was carried out, but the patient's postoperative course was complicated by a CSF leak due to a small connection that was obliterated in a second operation. Control MR imaging confirmed the removal of the cystic lesion. The clinical, neuroradiological and surgical features of this rare condition are discussed and the importance of a differential diagnosis is stressed.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"68 1","pages":"34-7"},"PeriodicalIF":0.0,"publicationDate":"2007-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2007-968169","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26711010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of intraoperative 3D-ultrasound in a commercial navigation system.","authors":"O Sergeeva,&nbsp;F Uhlemann,&nbsp;G Schackert,&nbsp;C Hergeth,&nbsp;U Morgenstern,&nbsp;R Steinmeier","doi":"10.1055/s-2006-942186","DOIUrl":"https://doi.org/10.1055/s-2006-942186","url":null,"abstract":"<p><strong>Study aims: </strong>The purpose of this study was the integration of three-dimensional ultrasound data into a neuronavigation system, in order to allow a guided intraoperative resection control during neurosurgical interventions.</p><p><strong>Material and methods: </strong>A system for iterative neuronavigation based on 3D-ultrasound (US) has been developed. The main components of the system are the ultrasound device Voluson 730 (GE Healthcare) with a 5 - 9 MHz probe, the navigation system VectorVision2 (BrainLAB AG) and a standard PC with Windows XP. The ultrasound data are transferred via DICOM from the ultrasound device to an external computer, where they are processed with a C++ program for representation in the neuronavigation coordinate system. The data transfer between the navigation system and the external computer is performed via the VVLink interface from BrainLAB. The feasibility test of the system was performed with an ultrasound phantom RMI 403GS (Gammex-RMI GmbH).</p><p><strong>Results: </strong>The error of homologous points mapping from US datasets to a CT dataset in the neuronavigation system was determined to be 1.9 +/- 0.97 mm. The maximum time required to technically integrate the ultrasound data into the navigation system was 1.5 min.</p><p><strong>Conclusions: </strong>The developed system allows 3D-ultrasound based navigation to be carried out with a commercially available navigation system. The functionality of this system has been proven by technical tests. Recording and integration of the ultrasound data can be repeated at any time during surgery and can be used to update anatomical data and consequently for resection control. Another application is the intraoperative adaptation of preoperative datasets (MRI or CT) in order to compensate for \"brain shift\" during neurosurgical operations.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 4","pages":"197-203"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26424268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramedullary teratomas: Two case reports and a review of the literature.","authors":"R Caruso,&nbsp;C Colonnese","doi":"10.1055/s-2006-942119","DOIUrl":"https://doi.org/10.1055/s-2006-942119","url":null,"abstract":"<p><strong>Objective: </strong>Intramedullary teratomas are extremely rare tumours. A review of the literature found only reports of 59 cases, three of which were treated by us. The most common localisation for these tumours is in the medullary conus. According to our experience as well as more recent reports, MRI images allow a preoperative diagnosis to be made.</p><p><strong>Clinical presentation: </strong>We treated two cases of intramedullary teratoma of the conus: that of a 41-year-old woman and that of a 40-year-old man. Both suffered from motor and sensory disorders, and the woman also suffered from urinary disorders. CT and MRI enabled us to diagnose an intramedullary tumour and to suspect a dysembryogenic origin.</p><p><strong>Intervention: </strong>Both patients were treated surgically; the surgical removal of the tumour was extensive but not total because of the tenacious adhesions of the tumour to the adjacent parenchyma.</p><p><strong>Conclusion: </strong>Surgery is the therapy of choice in cases of intramedullary teratomas; the removal, though incomplete, leads to a definite improvement of symptoms. In our two cases the follow-up has been 7 years and 6 years, respectively. No tumour regrowth occurred during this period.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 4","pages":"213-8"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26365968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Present practice and perspective of evaluation and surgery for temporal lobe epilepsy.","authors":"H Clusmann,&nbsp;T Kral,&nbsp;J Schramm","doi":"10.1055/s-2006-942144","DOIUrl":"https://doi.org/10.1055/s-2006-942144","url":null,"abstract":"<p><p>Surgery for temporal lobe epilepsy refractory to medical treatment is a promising treatment option. After a short overview of historical developments in this field, we describe the present practice of presurgical evaluation and resection strategies as practiced at our institution and review the corresponding publications from other centers. We will be trying to outline major future developments for the surgical therapy of temporal lobe epilepsy based on present trends.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 4","pages":"165-82"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26424267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nontraumatic spinal epidural hematoma associated with clopidogrel.","authors":"K Karabatsou,&nbsp;A Sinha,&nbsp;K Das,&nbsp;N G Rainov","doi":"10.1055/s-2006-933536","DOIUrl":"https://doi.org/10.1055/s-2006-933536","url":null,"abstract":"<p><p>A 73-year-old female treated with clopidogrel for vascular disease presented with sudden onset of back pain, urinary retention and paraplegia. MRI scans demonstrated a thoracolumbar epidural hematoma and the patient underwent emergency laminectomy for evacuation of the hematoma. A possible causal link between clopidogrel and occurrence of the hemorrhage is discussed and the literature on spontaneous spinal hematomas is reviewed.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 4","pages":"210-2"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-933536","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26365967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Image transfer by mobile phones in neurosurgery.","authors":"J Piek,&nbsp;R Hebecker,&nbsp;M Schütze,&nbsp;S Sola,&nbsp;S Mann,&nbsp;K Buchholz","doi":"10.1055/s-2006-942309","DOIUrl":"https://doi.org/10.1055/s-2006-942309","url":null,"abstract":"<p><p>Image transfer by mobile phones with built-in cameras (1 Megapixel CCD digital camera, 7 stage digital zoom, max. picture size 858 x 1 144 pixels, display resolution 240 x 320 dots, 262 K colour system CGS LCD) was introduced into clinical practice in the author's department in July 2004 to improve communication between neurosurgeons. During the first 12 months of use 13-72 images per month with an average of 1.4 images/case were transmitted via the regular German mobile phone net (GRPS standard, 40 KBit/s) among all neurosurgeons. Most images were transferred from the resident on call to the senior neurosurgeon backing him up. Overall, the system was extremely reliable, quick, and enabled immediate decisions in all emergency situations. In conclusion, image transfer by mobile phones has significantly improved communication within our department.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 4","pages":"193-6"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26473643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical response of cervical vertebral endplates to axial loading.","authors":"J Schröder,&nbsp;M Herbort,&nbsp;P Rustemeyer,&nbsp;V Vieth,&nbsp;H Wassmann","doi":"10.1055/s-2006-942279","DOIUrl":"https://doi.org/10.1055/s-2006-942279","url":null,"abstract":"<p><strong>Objective: </strong>After anterior cervical discectomy the implantation of a spacer is common practice. The majority of these spacers are trapezoid titanium cages. During the development of a height-adjustable cervical implant we needed to establish the testing limits for this device. A known phenomenon is subsidence of the cage into the vertebral endplates, which leads to a decrease in height and/or angulation of the cervical spinal segment. In contrast to the thoracic and lumbar spines, there are only limited data concerning the load-bearing ability of cervical endplates. The aim of our investigation was to obtain these data.</p><p><strong>Methods: </strong>Bone density of 16 cervical vertebrae was estimated by quantitative computed tomography. After embedding of the vertebrae into PMMA, each endplate was slowly compressed until failure using a metal indenter resembling the form of a newly developed cervical implant. A fixed protocol with increasing loading cycles was followed. Endpoint was breakage of the endplate as established by failure to resist the increasing loading forces produced by the testing machine.</p><p><strong>Results: </strong>The mean bone density of the 16 cervical vertebrae was 204 with a standard deviation of 52 mg Ca-HA/mL (range 130-281). The endplates failed with a mean loading of 1084 N +/- 314 (range 340-1550 N). The maximum load correlates with the bone density (R2 = 0.7347). With the 97.79 mm2 load bearing surface of the cage we calculate a mean cervical endplate break strength of 10.47 MPa and a 95 % confidence interval of 12.66-9.51 MPa. An initial settling produced by resting of the anchoring teeth in the cervical endplates was observed in 8 vertebrae at a load of 113 N (range 50-250 N).</p><p><strong>Conclusions: </strong>In contrast to the thoracic and lumbar spines, cervical endplates show a lower resistance against axial forces. The data are important to understand postoperative cage subsidence and to establish testing limits for the development of new implant designs.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 4","pages":"188-92"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942279","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26365965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective studies in patients with intraventricular haemorrhage without the capacity to give consent in Germany--a legal dilemma.","authors":"S Spuck,&nbsp;I R König,&nbsp;H Arnold,&nbsp;A Ziegler,&nbsp;G Nowak","doi":"10.1055/s-2006-942308","DOIUrl":"https://doi.org/10.1055/s-2006-942308","url":null,"abstract":"<p><strong>Objective: </strong>The prognosis of intracranial haemorrhage with ventricular participation is poor. The acute onset of hydrocephalus has to be treated with an external ventricular drainage. However, intraventricular blood clots often obstruct the drainage catheter; the reinsertion is usually associated with an increased risk of complications. Therefore, intraventricular thrombolysis using recombinant tissue plasminogen activator (rt-PA), urokinase or streptokinase has been performed in several cases. In Germany, rt-PA does not have approval for intraventricular applications, and the risks and benefits of this treatment are as yet unclear. Several authors recommend its use only in the frame of prospective studies, meaning that intraventricular administration of thrombolytic agents within an individual therapy trial could be viewed as medical malpractice.</p><p><strong>Methods: </strong>We designed a national prospective randomised and controlled study in patients with intraventricular haemorrhage to investigate the risks and effects of intraventricular rt-PA treatment. The local ethics committee and lawyers did not accept the study protocol due to a non-acceptable risk of complications. In two further conferences, the risk of undertreatment in the control group was a major reason not to accept the protocol. We discuss the conflicts of law in related studies.</p><p><strong>Conclusions: </strong>There is a need for a solution to the legal conflicts of medical malpractice, unclear risk-benefit ratio and unfeasibility due to risk of complications or undertreatment in studies with patients without the capacity to give informed consent.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 4","pages":"183-7"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26367861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}