Central European Neurosurgery最新文献

{"title":"WHO Grade III Anaplastic Meningioma Metastasizing to the Parotid Gland and the Lungs: Case Report and Review of the Literature.","authors":"A Herbst, U Mueller-Vogt, A Brawanski, M Proescholdt, M Riemenschneider, K-M Schebesch","doi":"10.1055/s-0031-1280838","DOIUrl":"https://doi.org/10.1055/s-0031-1280838","url":null,"abstract":"Bibliography DOI http://dx.doi.org/ 10.1055/s-0031-1280838 Published ahead of print Cen Eur Neurosurg © Georg Thieme Verlag KG Stuttgart ∙ New York ISSN 1868-4904 This article has now been published in the Journal of Neurological Surgery: Part A (DOI: 10.1055/s-0032-1313722) WHO Grade III Anaplastic Meningioma Metastasizing to the Parotid Gland and the Lungs: Case Report and Review of the Literature","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1280838","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30340472","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":"Elevated intracranial pressure, low cerebral perfusion pressure, and impaired brain metabolism correlate with fatal outcome after severe brain injury.","authors":"A Hejčl, M Bolcha, J Procházka, E Hušková, M Sameš","doi":"10.1055/s-0031-1275745","DOIUrl":"https://doi.org/10.1055/s-0031-1275745","url":null,"abstract":"Background  New brain tissue monitoring techniques (tissue oxymetry, microdialysis) provide direct information about the state of brain oxygenation and brain metabolism in patients with severe traumatic brain injury (TBI). Despite this information being limited to a small region of the brain surrounding the probes, it could be associated with such global parameters as the clinical outcome. Objective  To study the predictive value of monitoring brain oxygenation and metabolism on clinical outcome in patients in the acute phase of severe TBI. Methods  An observational study of 20 patients with a severe TBI was undertaken, utilizing intracranial pressure (ICP), cerebral perfusion pressure (CPP), brain tissue oxygenation, and brain metabolism monitoring. We correlated the clinical outcome of the patients with the following parameters: ICP, CPP, brain tissue oxymetry (PbtO 2 ), glucose and glycerol levels, and the lactate/pyruvate (LP) ratio. Further, we analyzed the relationship between ICP, CPP, PbtO 2 , and the metabolism parameters. Results  We found a correlation of the mean ICP values (8.73 ± 1.18 in group A vs. 26.32 ± 5.01 mmHg in group B, p p p p p p p 2 correlated with a high LP ratio (Spearman R = −0.49, p Conclusions  High ICP, low CPP, an elevated mean LP ratio, and high glycerol concentrations in the acute phase predict fatal outcome 6 months after TBI. Further, high ICP, low CPP, and low PbtO 2 correlate with impaired brain metabolism.","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1275745","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30214208","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":"An endoscopic endonsal transethmoidal approach to olfactory groove meningioma.","authors":"Y H Kim, D H Han, C-K Park, C H Lee, D G Kim","doi":"10.1055/s-0031-1291179","DOIUrl":"https://doi.org/10.1055/s-0031-1291179","url":null,"abstract":"Kim Y et al. An Endoscopic Endonsal Transethmoidal ... Cen Eur Neurosurg 2011; 72: 205–208 Introduction ▼ Olfactory groove meningiomas (OGMs) are traditionally accessed through a subfrontal, pterional, or interhemispheric approach. Although the removal of the bony structures of the skull base provides direct access to these tumors, these approaches still require some manipulation due to their lateral-to-medial trajectory [ 5 , 16 ] . In contrast, the endonasal transethmoidal approach for a centrally located anterior skull base lesion has the advantage of direct access to the lesion and possible feeding vessels without the need for retraction of the brain or neurovascular structures. In addition, recent advances in the understanding of skull base anatomy, accuracy of neuronavigation, and optical endoscopy technology promote the endoscopic endonasal approach for centrally located skull base lesions [ 6 ] . Based on this background, we report 2 OGM cases treated by a purely endoscopic endonasal transethmoidal approach and present the pros and cons of endoscopic endonasal surgical approaches for anterior skull base lesions.","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1291179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30248792","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":"Minimizing brain shift during functional neurosurgical procedures - a simple burr hole technique that can decrease CSF loss and intracranial air.","authors":"V A Coenen,&nbsp;A Abdel-Rahman,&nbsp;J McMaster,&nbsp;N Bogod,&nbsp;C R Honey","doi":"10.1055/s-0031-1279748","DOIUrl":"https://doi.org/10.1055/s-0031-1279748","url":null,"abstract":"<p><strong>Background: </strong>Exact stereotactic placement of deep brain stimulation electrodes during functional stereotactic neurosurgical procedures can be impeded by intraoperative brain shift. Brain shift has been shown to correlate with the amount of intracranial (subdural) air detected on early postoperative imaging studies. We report a simple burr hole technique that reduces the loss of cerebrospinal fluid (CSF) and has the potential to significantly reduce the amount of postoperative intracranial air.</p><p><strong>Material and methods: </strong>A total of 16 patients were studied with half (group 2) receiving the burr hole technique designed to seal the CSF space and thereby reducing CSF loss. The other 8 patients (group 1) received the standard burr hole technique. The 2 groups were of similar age, gender, diagnosis (Parkinson's disease, n=14; cervical dystonia n=2), and surgical targets. All patients received bilateral electrodes either in the subthalamic nucleus (STN, n=14) or in the globus pallidum internus (GPi, n=2) avoiding transventricular trajectories. Early postoperative 3-dimensional computed tomography (3D CT) was used to check for possible bleeding, DBS lead location, and the amount of intracranial air. Intracranial air was assessed manually in a volumetric slice-by-slice approach in the individual postoperative CT and the groups compared by t-test.</p><p><strong>Results: </strong>Group 2 showed significantly lower postoperative intracranial air volumes (4.86 ± 4.35cc) as compared to group 1 (27.59 ± 17.80 cc, p=0.0083*). The duration of surgery, however, was significantly longer for group 1 (435 ± 56.05 min) as compared to group 2 (316 ± 34.79 min,p=0.00015*).The time span between the conclusion of the operation and postoperative 3DCT was similar for both groups.</p><p><strong>Conclusion: </strong>This new and simple burr hole technique was associated with a significant reduction in postoperative intracranial air. Reduction of intracranial air will ultimately reduce brain shift. That total operation time does not influence intracranial air is discussed as well as the limitations of this pilot series. In the authors' opinion, this straightforward and cost-effective technique has the potential to reduce brain shift and to increase DBS placement accuracy during functional stereotactic neurosurgical procedures performed in the seated or half-sitting position. A larger more standardized patient series is necessary to substantiate the findings.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1279748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29992868","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":"Transorbital penetrating skull-base injuries: two severe cases with wooden branches and review of the literature.","authors":"K Zweckberger,&nbsp;C Jung,&nbsp;A Unterberg,&nbsp;U Schick","doi":"10.1055/s-0030-1262789","DOIUrl":"https://doi.org/10.1055/s-0030-1262789","url":null,"abstract":"Zweckberger K et al. Transorbital Penetrating Skull-Base Injuries ... Cen Eur Neurosurg 2011; 72: 201 – 205 Introduction ▼ Penetrating transorbital skull-base injuries are scarce in Europe, and therefore still remain challenging in their operative and intensive care therapy. Apart from missile and war associated experiences [1, 2] , only a few spectacular case reports on injuries with, for example, an arrow, screwdrivers, chopsticks or wild deer ’ s antlers [3 – 7] , and small series are available in the literature. As injury patterns vary widely, cases of penetrating transorbital skull-base injuries can strongly differ from each other. Therefore, therapy and outcome for the patients depend on the exact pattern of injuries, especially the involvement of the orbit, cranial nerves, intracranial vessels, and the subsequent development of intracerebral infection. In this article, we present 2 at fi rst apparently similar cases of severe penetrating transorbital skull-base injuries with wooden sticks. However, the outcomes were completely diff erent, which was related to the diff erent involvement of cranial nerves and intra cranial vessels.","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1262789","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29854249","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":"Ganglioglioma of the right lateral ventricle approached with neuronavigation and intraoperative DTI. Case report and literature review.","authors":"G d'Andrea,&nbsp;G Sessa,&nbsp;L Ferrante","doi":"10.1055/s-0031-1275287","DOIUrl":"https://doi.org/10.1055/s-0031-1275287","url":null,"abstract":"<p><strong>Unlabelled: </strong>BACKGROUND AND STUDY OBJECT: We describe the case of a young patient treated for a ganglioglioma of the right lateral ventricle. The ganglioma was approached via a temporal route using neuronavigation. Such lesions, if confined to the ventricular system and, especially, to the lateral ventricle, are unusual.</p><p><strong>Case report: </strong>A 22-year-old male was admitted because of headache and seizures. Magnetic resonance imaging (MRI) revealed a neoplasm in the temporal horn of the right lateral ventricle. A CT scan demonstrated calcifications. After preoperative planning, the patient was scheduled for neuronavigated operation. A small temporal craniotomy was performed. Once the dura was opened, we acquired a volumetric intraoperative MRI with diffusion tensor imaging (DTI). The optic tract was visualized again on intraoperative DTI and the volumetric MRI was used to update the navigational data.</p><p><strong>Results: </strong>The temporal corticotomy between the inferior and the middle temporal gyrus was guided by neuronavigation, keeping the surgical corridor in distance to the optic tract until the tumor was reached. After tumor resection, we repeated intraoperative MRI with DTI, which confirmed complete tumor removal and the patency of the optic pathway. Our protocol allowed us to reach the lesion via a minimally invasive approach with near real-time control of the integrity of the optic tract during surgery. DTI was acquired preoperatively and during surgery, avoiding inaccuracy due to brain shift.</p><p><strong>Conclusions: </strong>Intraoperative MRI with DTI allows to treat such lesions via minimally invasive approaches and to reduce operative morbidity due to fiber tract damage.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1275287","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30059468","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":"Congenital cervical tethered cord in an adult: utility of spinal diffusion tensor MR imaging.","authors":"N O Schmidt,&nbsp;F Raimund,&nbsp;A-F Förster,&nbsp;J Matschke,&nbsp;J Regelsberger,&nbsp;J Fiehler,&nbsp;D Winkler,&nbsp;M Westphal","doi":"10.1055/s-0030-1268501","DOIUrl":"https://doi.org/10.1055/s-0030-1268501","url":null,"abstract":"Schmidt NO et al. Congenital Cervical Tethered Cord ... Cen Eur Neurosurg 2011; 72: 208 – 21","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1268501","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29533184","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":"Management of patients with low-grade gliomas - a survey among German neurosurgical departments.","authors":"M Seiz,&nbsp;C F Freyschlag,&nbsp;S Schenkel,&nbsp;C Weiss,&nbsp;C Thomé,&nbsp;K Schmieder,&nbsp;W Stummer,&nbsp;J Tuettenberg","doi":"10.1055/s-0031-1275351","DOIUrl":"https://doi.org/10.1055/s-0031-1275351","url":null,"abstract":"<p><strong>Background and aims of the study: </strong>The diagnosis and treatment of low-grade gliomas (LGG) are multimodal. Today, there is no defined standard in diagnosis and treatment. Controversies are, in general, about a \"wait-and-see\" strategy, diagnostic workup, surgical intervention, postoperative imaging, adjuvant treatment, and follow-up. The aim of this study is to gain an overview about management strategies of high-volume German neurosurgical departments treating these patients.</p><p><strong>Material and methods: </strong>A questionnaire including diagnostic, preoperative, perioperative, and postoperative parameters and 5 cases with magnetic resonance imaging data with questions to various treatment options in these patients was sent to all 34 German neurosurgical departments at university hospitals.</p><p><strong>Results: </strong>In total, 24 questionnaires were returned and analysed. Centres were divided into those who generally practice a \"wait-and-see\" strategy vs. those who do not or only in highly selected cases. Statistical analyses were performed with Fisher test and Chi (2)-test. Interestingly, 50% of all centres routinely follow a \"wait-and-see\" strategy.</p><p><strong>Conclusion: </strong>Although the management of patients with LGG is complex and a simple questionnaire will not be able to define a standard in diagnosis and treatment, this study offers an overview on strategies at high-volume academic centres dealing with these patients. There is consensus to resect superficially located lobar and circumscribed low-grade lesions. However, the differences between centres become apparent with increasing complexity of the lesions.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1275351","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29885333","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":"Cervical pneumorrhachis caused by impact loading forces after skull base fracture: case report and review of the literature.","authors":"G Bozkurt,&nbsp;C C Turk,&nbsp;S Ayhan,&nbsp;A Akbay,&nbsp;S Palaoglu","doi":"10.1055/s-0030-1252008","DOIUrl":"https://doi.org/10.1055/s-0030-1252008","url":null,"abstract":"Bozkurt G et al. Cervical Pneumorrhachis caused by Impact Loading Forces ... Cen Eur Neurosurg 2011; 72: 215 – 218 Introduction ▼ The presence of air in the spinal canal is referred to as pneumorrhachis (PR). The proposed causes of PR are iatrogenic, non-traumatic, and traumatic [7, 14] . Air in the spinal canal may be extradural (epidural) or intradural (subdural and subarachnoid) and is found in an isolated form at the cervical, thoracic, and lumbosacral levels or as a diff use form in the entire spinal canal [14] . Traumatic PR can be also classifi ed as intradural (subdural or subarachnoid) or extradural (epidural) and is associated with diff erent pathophysiologic mechanisms and causes [7, 14] . In general, the occurrence of air within the epidural space is more common than intradural PR. The presence of epidural air has a diff erent implication from subarachnoid PR. Epidural PR is usually benign, innocent, asymptomatic, resolves spontaneously and is usually localized to a fracture line [7, 14] . The underlying cause should be treated. Traumatic subarachnoid PR is secondary to major trauma, and usually accepted as an indirect sign of severe injury. Traumatic subarachnoid PR, which is almost always associated with pneumocephalus, needs more detailed investigation, close monitoring, and follow-up because air in the subarachnoid space may lead to increased or decreased intracranial and intraspinal pressure as it moves up or down, resulting in neurological signs and symptoms [22] and even mortality [3, 16] . The management of subarachnoid air is not just limited to the underlying cause. Potential complications such as persistent pneumocephalus and infection associated with subarachnoid PR should be prevented and, if necessary, the torn dura should be repaired. Although a head or face-down position with the patient in a horizontal position during the accident is an important mechanism of cervical PR formation after head trauma and / or skull base fracture, the importance of the degree and severity of the impact has not been reported previously [1 – 3, 7 – 10, 13 – 16, 20, 22] . To the best of our knowledge, only fourteen cases of isolated traumatic cervical intradural PR secondary to open skull fracture and skull base fracture have been reported in the literature [1 – 3, 7 – 10, 13 – 16, 20, 22] . We performed a review of the comprehensive literature of the U. S. National Library of Medicine ’ s Medline bibliographic database to compare the diff erent mechanisms of injury proposed for this kind of lesion. In this case report, its clinical importance is also discussed.","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1252008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29044284","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":"Training microneurosurgery - four years experiences with an in vivo model.","authors":"J Regelsberger,&nbsp;O Heese,&nbsp;P Horn,&nbsp;M Kirsch,&nbsp;S Eicker,&nbsp;M Sabel,&nbsp;M Westphal","doi":"10.1055/s-0030-1261906","DOIUrl":"https://doi.org/10.1055/s-0030-1261906","url":null,"abstract":"<p><strong>Objective: </strong>Enquiries among surgical trainees revealed an increasing discontent regarding their quality of training. 40 % of young surgical trainees judge their training as inadequate and 70% are offered no structured training programme. Working time restrictions and economic pressure may be strong factors hindering residents from becoming skillful surgeons. Therefore, additional forms of training seem to be needed.</p><p><strong>Method: </strong>An in vivo swine model was evaluated for its practical use in training neurosurgical residents. Surgical procedures included craniotomy, dural opening, brain surgery and excision of an artificial tumour created by injection of coloured fibrin glue. Microscopy and bleeding management with bipolar cautery and haemostyptics were an integrated part of training. Supervision by experienced neurosurgeons with up to 3 trainees in a 2-day course was warranted. Standardised questionnairies before and after training were used to assess the quality and utility of the programme.</p><p><strong>Results: </strong>24 residents have participated in the course (1 (st)-5 (th) year of training). Minor experience with less than 100 conducting surgeries was seen in 59% of trainees. 14 residents had participated in more than 100 surgeries as first assistant. Spinal surgery was the predominant common experience. All participants judged their surgical training as insufficient. 77% had no microsurgical lab at their clinics. Expectations for the course were met for all trainees and the tutorials judged as excellent (65%) or good (35%). Positive evaluations of the in vivo model (97%), a realistic laboratory setup (94%), the working environment (94%) and close supervision (94%) showed that these were the most favourable aspects of the course.</p><p><strong>Conclusion: </strong>Educational training in surgical specialities is becoming a major problem in our daily practice and requires additional training facilities. In this context, in vivo models are an ideal opportunity for young neurosurgeons to train bleeding management and surgical complications in particular. This educational form is thought to be a unique training model which is now added by spinal and neurovascular courses.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1261906","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29128726","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}