Zentralblatt Fur Neurochirurgie最新文献

{"title":"Prognostic and survival-related factors in patients with well-differentiated oligodendrogliomas.","authors":"F Maiuri,&nbsp;M L Del Basso De Caro,&nbsp;G Iaconetta,&nbsp;C Peca,&nbsp;M Esposito,&nbsp;E de Divitiis","doi":"10.1055/s-2006-942138","DOIUrl":"https://doi.org/10.1055/s-2006-942138","url":null,"abstract":"<p><p>Oligodendrogliomas are brain tumors with unpredictable biological and clinical behavior. Prognostic factors related to survival are still controversial. The present study reviews 50 patients with well-differentiated (WHO grade II) oligodendrogliomas, located in the cerebral hemispheres and operated upon between 1980 and 1998. Prognostic factors studied include patient's age and sex, tumor location and extent, preoperative KPS, and extent of the surgical resection. The Ki-67 and the proliferative cell nuclear antigen (PCNA) levels were studied in all patients and some growth factors (GFs), including vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), platelet-derived growth factor (PDGF) and tenascine were examined in 20 patients. The long-term outcome and survival are not significantly correlated with the patient's age and sex, tumor location and extent, preoperative KPS and procedure for resection. Patients with lower Ki-67 and PCNA showed a significantly longer survival time (p < 0.001 and p < 0.019, respectively). Between 45 and 70 % of the tumors stained positive for one or more growth factors. Interestingly, cases with late recurrences (more than 4 years after surgery) and longer survival are significantly associated to negative GF expression or slight positivity, as compared with the variable and more often moderate immunoreactivity of cases with early anaplastic recurrences and shorter survival time. The presented data suggest that low proliferation indices and negative GF expression are associated with longer survival in well-differentiated oligodendrogliomas.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 4","pages":"204-9"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26365966","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":"Alveolar rhabdomyosarcoma of the clivus with intrasellar expansion: Case report.","authors":"M Seiz,&nbsp;M Radek,&nbsp;R Buslei,&nbsp;J Kreutzer,&nbsp;B Hofmann,&nbsp;U Kottler,&nbsp;A Doerfler,&nbsp;C Nimsky,&nbsp;R Fahlbusch","doi":"10.1055/s-2006-942118","DOIUrl":"https://doi.org/10.1055/s-2006-942118","url":null,"abstract":"<p><p>Rhabdomyosarcomas are common tumors of the head and neck region in children. However, a primarily intracranial localization of this tumor entity is rare. We report on a 3-year-old boy presenting with double vision due to left VI (th) nerve palsy. No other neurological deficits were recognized by clinical inspection. MRI scans visualized an enhancing mass lesion in the upper clivus compressing the cavernous sinus and the pituitary gland. Transsphenoidal biopsy was performed and histopathological examination as well as molecular diagnostics confirmed the diagnosis of an alveolar rhabdomyosarcoma (ARMS). Staging identified a metastatic lesion in the fourth thoracic vertebra resulting in the diagnosis of stage IV disease. Treatment modality included stereotactic radio- and chemotherapy.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 4","pages":"219-22"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26473644","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":"[biogf].","authors":"K Roosen,&nbsp;H Arnold","doi":"10.1055/s-2006-942254","DOIUrl":"https://doi.org/10.1055/s-2006-942254","url":null,"abstract":"Als drittes von vier Kindern wurde er am 19.2.1920 in Bochum geboren. Von 1926–1938 absolvierte er die Grundund Oberrealschule in Bochum. Das durch Kriegsverwendung in sizilianischen Lazaretten mehrfach unterbrochene Medizinstudium begann er 1939 in Leipzig und setzte es in Marburg, Heidelberg und Innsbruck fort. Am 2.4.1945 legte er in Graz das Staatsexamen ab. 3 Tage später promovierte er mit einer Arbeit „Über den vorzeitigen Blasensprung und seine Latenzzeit“. Tage danach floh er vor den anrückenden russischen Truppen mit dem Fahrrad in die britische Besatzungszone. Er kehrte nach Graz zurück, nachdem es durch die Briten wiederbesetzt war, und begann am 1.8.1945 seine klinische Ausbildung an der dortigen Nervenklinik.","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 3","pages":"155-6"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942254","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26241502","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":"Spontaneous cerebrospinal fluid rhinorrhea in untreated macroprolactinoma--an indication for primary surgical therapy.","authors":"J B Honegger,&nbsp;T Psaras,&nbsp;M Petrick,&nbsp;F Beuschlein,&nbsp;M Reincke","doi":"10.1055/s-2006-942145","DOIUrl":"https://doi.org/10.1055/s-2006-942145","url":null,"abstract":"<p><strong>Background: </strong>Medical therapy is usually indicated as first-line treatment for prolactinomas. Surgery is generally reserved as second-line therapy if prolactinomas are non-responsive to dopamine agonists (DA) or DA therapy is not tolerated. Herein, we draw attention to the rare occurrence of spontaneous CSF rhinorrhea in prolactinomas requiring primary surgical therapy. Only 8 cases of confirmed prolactinomas with spontaneous rhinorrhea have been reported in the literature so far.</p><p><strong>Case reports: </strong>Two out of 267 surgical cases with pituitary adenomas presented with spontaneous rhinorrhea. Both patients harbored invasive prolactinomas. In both cases, the defect was exposed using a transsphenoidal procedure and was sealed with fascia lata.</p><p><strong>Results: </strong>Urgent surgical repair of the leak prevented meningitis. In one case, a second operation was required due to recurrent rhinorrhea under postoperative dopamine-agonist therapy of the residual tumor. The clinical course was otherwise uncomplicated.</p><p><strong>Conclusion: </strong>Certain clinical settings still require primary surgical therapy of prolactinomas. Spontaneous rhinorrhea caused by invasive macroprolactinomas represents a mandatory indication for initial surgery. Early detection and surgical repair of a CSF leak is crucial for a favorable clinical outcome.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 3","pages":"149-54"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26299044","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":"Outcomes of surgical resection of large solitary hemangioblastomas of the craniocervical junction with limitations in preoperative angiographic intervention: report of three cases.","authors":"K G Krishnan,&nbsp;G Schackert","doi":"10.1055/s-2006-933360","DOIUrl":"https://doi.org/10.1055/s-2006-933360","url":null,"abstract":"<p><strong>Introduction: </strong>Hemangioblastomas of the central nervous system may occur sporadically, or in association with von Hippel-Lindau (vHL) disease. The treatment of large solitary hemangioblastomas of the posterior cranial fossa mandates a combination of angiographic intervention and surgery. However, large tumors may derive their vascularity from major cerebellar vessels, which can make their embolization hazardous.</p><p><strong>Aim: </strong>To describe the surgical outcomes of three cases of large hemangioblastomas with compression of the medulla oblongata, where the potential for preoperative embolization was extremely limited.</p><p><strong>Cases: </strong>Three patients (all males; 68, 36 and 38 years) presented with a history of chronic headache and caudal cranial nerve deficiencies. Diagnostic imaging showed large vascular lesions (4 x 3, 4 x 5 and 5 x 5 cm) at the craniocervical junction, compressing the brainstem. There were no concomitant findings associated with vHL disease.</p><p><strong>Treatment: </strong>Staged treatment was administered. Preoperative embolization was attempted at first. One patient (68 yrs) showed a PICA occlusion and associated cerebellar infarction after embolization; embolization was deemed hazardous in the other two. In the second phase, the lesions were removed via a midline suboccipital approach with resection of the arch of altas. Complete removal was possible in all three cases. POSTOPERATIVE COURSE AND FOLLOW-UP: The caudal cranial nerve deficiencies deteriorated soon after surgery in all three patients. A tracheotomy was required in two patients, which was removed uneventfully during the rehabilitation phase. Ventriculo-peritoneal shunts were implanted in two patients. MRI follow-up three (1 case) and four years (2 cases) after surgery showed no relapse. The Karnofsky Index scores were 80, 70 and 90 in the three patients aged 68, 36 and 38, respectively.</p><p><strong>Conclusion: </strong>Total microneurosurgical removal of large hemangioblastomas at the craniocervical junction with limited preoperative embolization (associated with morbidity) should be seriously considered. Although the early outcome is not encouraging, the long-term outcomes seem favorable.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 3","pages":"137-43"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-933360","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26299042","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":"Intradural-extramedullary cavernous hemangioma of the left motor root C7--case report and update of the literature.","authors":"J Rachinger,&nbsp;R Buslei,&nbsp;T Engelhorn,&nbsp;A Doerfler,&nbsp;C Strauss","doi":"10.1055/s-2006-933362","DOIUrl":"https://doi.org/10.1055/s-2006-933362","url":null,"abstract":"<p><strong>Objective: </strong>Intradural-extramedullary cavernomas of the spine are rare lesions with only 21 published cases to date. Due to their rareness and special characteristics diagnosis often is difficult. We report on an additional case of an intradural-extramedullary cavernoma of the spine.</p><p><strong>Patient: </strong>A 56-year-old male presented with left shoulder pain and acute onset of pain affecting the whole spinal column two weeks prior to admission. There were no motor deficits, but a hypesthesia corresponding to the right distal C8-dermatome. MRI revealed an intradural-extramedullary, expansive lesion at the level of C6 with a hyperintense appearance in both T (1)- and T (2)-weighted images. Neither a hemosiderin rim nor contrast enhancement was visible.</p><p><strong>Results: </strong>During surgery a hematoma and a reddish, berry-like tumor adherent to the left motor root C7 were removed. There were no new neurological deficits, and shoulder and back pain resolved within a few weeks after surgery. Histopathologically a cavernous hemangioma was diagnosed.</p><p><strong>Conclusions: </strong>The patient's symptoms were caused both by direct nerve compression and by spinal hemorrhage, most likely spinal SAH. As there was no characteristic hemosiderin rim and due to the hyperintense appearance in T (1)- and T (2)-weighted MR scans, a radiological diagnosis of hemorrhage and classification of the lesion was difficult. Despite their rareness, in patients with signs of spontaneous, spinal SAH and/or nerve compression syndromes cavernous hemangiomas have to be considered as a potential cause.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 3","pages":"144-8"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-933362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26299043","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":"“eFirst” - Thieme's New Online Service","authors":"","doi":"10.1055/s-2006-942155","DOIUrl":"https://doi.org/10.1055/s-2006-942155","url":null,"abstract":"","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 1","pages":"109 - 109"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58076929","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":"Spinal navigation: an accepted standard of care?","authors":"J Schröder,&nbsp;H Wassmann","doi":"10.1055/s-2006-942146","DOIUrl":"https://doi.org/10.1055/s-2006-942146","url":null,"abstract":"<p><strong>Objective: </strong>In contrast to cranial neuro-navigation, which has been accepted as a routine intraoperative tool, there is still much debate about spinal navigation as an aid for the insertion of pedicle screws. Opinions range from \"not useful at all\" to \"malpractice if not using it\". The aim of our investigation was to obtain data about the availability of spinal navigation and compile a common opinion among German neurosurgeons about its usefulness. The current literature is reviewed.</p><p><strong>Methods: </strong>We present the results of a survey of the Commission for Technical Standards of the German Neurosurgical Society about the use of intraoperative computerised spinal navigation.</p><p><strong>Results: </strong>Of the 128 neurosurgical departments surveyed, 107 (84 %) responded. 57 (53 %) of the responders are equipped with a spinal navigation device, 12 (11 %) use a spinal navigation equipment together with other departments, and 38 (36 %) do not have spinal navigation. Of the departments not equipped with spinal navigation, 58 % would like to have it but 42 % would not. 52 (49 %) responders held the opinion that spinal navigation enhances safety when introducing pedicle screws; while 40 (37 %) answered in the negative, and 15 (14 %) were not sure. Of the responders, 101 (94 %) disagreed with the statement that spinal navigation should be mandatory for pedicle screw placement, 3 (3 %) agreed, and 3 (3 %) were not sure. Of the responders, 105 (98 %) rejected the statement that insertion of pedicle screws without navigation is medical malpractice, 1 (1 %) upheld the statement, and 1 (1 %) was not sure.</p><p><strong>Conclusion: </strong>It is still not generally considered common practice to use spinal navigation as an aid for the implantation of pedicle screws. Most pedicle screws are still inserted conventionally. Although nearly 50 % of German neurosurgeons believe that spinal navigation could enhance safety when placing pedicle screws, they clearly reject efforts to make spinal navigation mandatory. With only one exception, the German neurosurgical community unanimously rejects the idea that placing pedicle screws without spinal navigation is medical malpractice.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 3","pages":"123-8"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26299040","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":"Genetics of cerebral cavernous angioma.","authors":"U Felbor,&nbsp;U Sure,&nbsp;T Grimm,&nbsp;H Bertalanffy","doi":"10.1055/s-2006-933537","DOIUrl":"https://doi.org/10.1055/s-2006-933537","url":null,"abstract":"<p><p>Cerebral cavernous malformations (CCM) are hamartomatous vascular anomalies characterized by densely packed, grossly enlarged immature capillaries without intervening neural tissue. Depending on their location and size (ranging from a few millimeters to several centimeters), the biologically dynamic lesions become symptomatic during the second to fourth decade of life. Clinical symptoms include recurrent headaches, seizures, intracranial hemorrhage, and stroke. There are sporadic and autosomal dominantly inherited forms of CCM. Causal mutations have been demonstrated in three genes, KRIT1, MGC4607, and PDCD10, but additional genes are likely to be discovered. These genes are therefore thought to play a role in angiogenesis. Their specific modes of actions, their contribution to and their likely penetrance in the genesis of CCM are the subject of current investigations. Genetic counseling is strongly advisable for patients with a positive family history and for seemingly sporadic cases with multiple lesions, and genetic testing should be considered on an individual basis. The identification of a mutation enables precise genetic testing of relatives. Given the 50 % a priori risk of autosomal dominant inheritance, the benefits of genetic testing are twofold: a positive test result in a presymptomatic carrier permits close neuroradiological surveillance and timely neurosurgical intervention; a negative test result relieves the proband of unwarranted anxiety and unnecessary medical supervision.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 3","pages":"110-6"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-933537","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26299037","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":"Electrophysiological proof of diffusion-weighted imaging-derived depiction of the deep-seated pyramidal tract in human.","authors":"V A Coenen,&nbsp;C Fromm,&nbsp;M Kronenbürger,&nbsp;I Rohde,&nbsp;P C Reinacher,&nbsp;R Becker,&nbsp;B Marks,&nbsp;J M Gilsbach,&nbsp;V Rohde","doi":"10.1055/s-2006-942117","DOIUrl":"https://doi.org/10.1055/s-2006-942117","url":null,"abstract":"<p><p>In the living human brain the pyramidal tract (PT) can be displayed with magnetic resonance diffusion-weighted imaging (DWI). Although this imaging technique is already being used for planning and performing neurosurgical procedures in the PT vicinity, there is a lack of verification of DWI accuracy in other areas outside the directly subcortical PT parts. Before definitive electrode placement into the subthalamic nucleus (STN) in patients with Parkinson disease (PD) for chronic stimulation, the stimulation effect on PD symptoms and the side-effects, namely PT activation at the level of the internal capsule (IC), are electrophysiologically tested. To analyze DWI accuracy by matching the stereotactic coordinates of the electrophysiologically proven IC position with these of the DWI-derived IC display, DWI was added to the routine MRI work-up in the stereotactic frame prior to functional surgery in 6 patients. In all of the 10 displayed fiber tracts, concordant findings for imaging and macrostimulation were made. The authors proved for the first time that DWI correctly depicts the deep seated, principle motor pathways in the living human brain. Due to methodical limitations of this study the accuracy of the proven IC display is limited to 3 mm which has proven to be sufficient for the planning and performance of neurosurgical procedures in the vicinity of large fiber tracts.</p>","PeriodicalId":50708,"journal":{"name":"Zentralblatt Fur Neurochirurgie","volume":"67 3","pages":"117-22"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2006-942117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26299039","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}