Central European Neurosurgery最新文献

{"title":"Long-term follow-up of a non-infantile desmoplastic ganglioglioma.","authors":"K Nanassis,&nbsp;P P Tsitsopoulos,&nbsp;D Marinopoulos,&nbsp;I Venizelos,&nbsp;P D Tsitsopoulos","doi":"10.1055/s-0029-1241180","DOIUrl":"https://doi.org/10.1055/s-0029-1241180","url":null,"abstract":"<p><p>Desmoplastic gangliogliomas are mixed cerebral tumors traditionally reported in infants. However, a few non-infantile cases have been documented. A case of a desmoplastic ganglioglioma in a 16-year male is presented. The patient reported severe headaches. Radiological examination revealed a large mass occupying the right frontal lobe. The lesion was totally excised. Histopathological examination confirmed the diagnosis of a desmoplastic ganglioglioma. The postoperative course was excellent. At the 10(1/2) year follow-up there was no evidence of tumor recurrence. Although desmoplastic gangliogliomas have aggressive features, complete surgical removal is the treatment of choice obviating the need for adjuvant therapy.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1241180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28606152","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":"Contrast enhancement and histopathological findings in vestibular schwannoma.","authors":"C Scheller,&nbsp;S Rampp,&nbsp;J C Rachinger,&nbsp;J Prell,&nbsp;S Koesling,&nbsp;S Becker,&nbsp;C Strauss","doi":"10.1055/s-0029-1225326","DOIUrl":"https://doi.org/10.1055/s-0029-1225326","url":null,"abstract":"<p><p>Changes of contrast uptake are considered to indicate the efficacy of therapy in irradiated vestibular schwannomas. We present a case of a large vestibular schwannoma with heterogeneous contrast uptake on MRI. Using neuronavigation, histological samples were obtained during surgery from an area with homogeneous contrast uptake and from a central tumor portion without contrast enhancement on MRI. Intraoperative investigation found no evidence of necrotic tumor, and histopathological examination revealed an active tumor in both sections, with no central necrosis. This finding illustrates the surgical experience that \" necrotic tumor areas \" on MRI may not be consistent with intraoperative findings. Lack of contrast uptake in previously irradiated schwannomas may not be indicative of effective radiotherapy.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1225326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28751674","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":"Extended extra- and intracerebral ulceration and brain abscess following self-mutilation in an auto-aggressive 51-year-old woman: case report.","authors":"K M Schebesch,&nbsp;A Herbst,&nbsp;P Schoedel,&nbsp;F Rockmann,&nbsp;A Brawanski","doi":"10.1055/s-0029-1214383","DOIUrl":"https://doi.org/10.1055/s-0029-1214383","url":null,"abstract":"<p><p>In neurosurgical practice, the operative treatment of deep or infected wounds caused by auto-mutilation is quite rare, especially in the neurocranium. We present an extraordinary case of an auto-aggressive 51-year-old female suffering from a deeply ulcerated wound on the right frontal skull with consecutive brain abscess, caused manually with needles and forceps over a period of 8 months. The clinical course is present ed together with a description of the conservative and surgical regimen and is illustrated with photographs and CT and MRI images.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1214383","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28751675","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":"Therapeutic clues in spinal dural arteriovenous fistulas - a 30 year experience of 156 cases.","authors":"C Hessler,&nbsp;J Regelsberger,&nbsp;U Grzyska,&nbsp;T Illies,&nbsp;H Zeumer,&nbsp;M Westphal","doi":"10.1055/s-0029-1224195","DOIUrl":"https://doi.org/10.1055/s-0029-1224195","url":null,"abstract":"<p><strong>Background: </strong>Spinal dural arteriovenous fistulae (SDAVF) are rare but remain the most common type of spinal vascular malformations. Treatment options for SDAVF include endovascular embolization, microsurgical dissection or a combination of both. But the optimal treatment paradigm has yet to be defined and may well be an individualized interdisciplinary combinatorial approach.</p><p><strong>Material and methods: </strong>From 1980 to 2008, 156 patients with the diagnosis of SDAVF were treated by neuroradiological and neurosurgical means. Based on the procedure-related complications we retrospectively analyzed our data to elucidate the reasons for endovascular failure and the evolution of the surgical technique.</p><p><strong>Results: </strong>156 patients were included in this study. There were 31 (19.9%) female and 125 (80.1%) male patients. Average age at the time of diagnosis was 60.8 years. 102 out of 156 (65.4%) underwent endovascular obliteration, 54 (34.6%) patients were treated primarily by surgery. 134 (85.9%) underwent follow-up examination. A total of 29 (18.6%) out of 156 patients could not be treated successfully by endovascular (9.4%) or surgical (4.1%) means.</p><p><strong>Conclusion: </strong>Microsurgery can be recommended as the first choice treatment when the fistula's point is unmistakably identified intradurally. Endovascular obliteration may be justifiable in cases with an easy access to a monoradicular feeding artery during diagnostic angiography. Surgery is a definitive treatment with stable long-term results in which procedure-related morbidity is low. During evolution of the combined approach, endovascular coil placement for correct localization of the fistula and the use of intraoperative micro-Doppler was found to be very helpful in increasing the safety of the surgical procedure and minimizing surgical exposure.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1224195","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40039195","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":"Depression and anxiety in patients undergoing herniated disc surgery: relevant but underresearched - a systematic review.","authors":"M Zieger,&nbsp;R Schwarz,&nbsp;H-H König,&nbsp;M Härter,&nbsp;S G Riedel-Heller","doi":"10.1055/s-0029-1225325","DOIUrl":"https://doi.org/10.1055/s-0029-1225325","url":null,"abstract":"<p><strong>Background: </strong>An association between depression and anxiety and musculoskeletal disorders has been consistently reported in the past years. This article provides a systematic overview of the literature on the prevalence rates of depression and anxiety in patients undergoing surgery for a herniated disc.</p><p><strong>Methods: </strong>A systematic literature search was conducted in the following electronic databases: PubMed, PsycINFO, Web of Science, Cochrane Library and PSYNDEXplus. The identified articles were evaluated for prevalence rates of depression and anxiety, methodological issues, change of depression and anxiety over time, and major findings on the impact of depression and anxiety on patients undergoing disc surgery.</p><p><strong>Results: </strong>Fourteen studies were identified. Prevalence rates for depression and anxiety in patients undergoing disc surgery varied between 21.5% and 49.3% before and between 4.1% and 79.6% after disc surgery. The study designs, the use of assessment instruments and cut-off values varied greatly. Depression and anxiety decreased within the population of disc surgery patients over time. Depression and anxiety were found to have a great impact on the postoperative outcome of surgery, return to work, analgesia abuse, pain experience, and abnormal illness behaviour.</p><p><strong>Conclusions: </strong>Little research has been done to investigate depression and anxiety in patients undergoing surgery for a herniated disc. Evidently disc surgery patients are at higher risk of suffering from depression and anxiety than the general population. The review outlines the importance for clinicians to be more sensitive to psychological concerns in patients undergoing disc surgery. Psychological assessment and assistance from mental health professionals should be considered during the hospital stay and rehabilitation period, depending on local feasibility. Further investigations are necessary to examine whether the implementation of a multidisciplinary in-patient treatment program will improve postoperative outcome in patients undergoing intervertebral disc surgery.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1225325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28666061","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":"Formation of two consecutive intrathecal catheter tip granulomas within nine months.","authors":"P Hoederath,&nbsp;O P Gautschi,&nbsp;M Land,&nbsp;G Hildebrandt,&nbsp;J Y Fournier","doi":"10.1055/s-0029-1202359","DOIUrl":"https://doi.org/10.1055/s-0029-1202359","url":null,"abstract":"<p><p>The formation of catheter tip granulomas is an increasingly observed serious complication of intrathecally administered medication. This complication, which is frequently associated with neurological disturbances, has previously been attributed to high dosages and high concentrations of intrathecal morphine. Much less commonly, intrathecal hydromorphone and intrathecal baclofen have also been associated with intrathecal granuloma formation. In the current case, we report a patient who developed her fi rst catheter tip granuloma after 20 months of intrathecal morphine. After surgical granuloma removal and installation of a new catheter, the patient received intrathecal ziconitide for an interim period of six months. Because of a progressive inefficacy, ziconitide was replaced by hydromorphone. One month later, only nine months after the fi rst operative granuloma removal, a new catheter tip granuloma required a further surgical intervention. This case report highlights the potential of intrathecal morphine and hydromorphone to form consecutive inflammatory granulomas within the same patient. To the best of our knowledge, this is the fi rst report of a patient developing two consecutive catheter tip granulomas within nine months.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1202359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28751676","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":"Endovascular coiling in 131 patients with low complication rate justifies treating most unruptured intracranial aneurysms.","authors":"V Benes,&nbsp;P Mitchell,&nbsp;A J Molyneux,&nbsp;S A Renowden","doi":"10.1055/s-0029-1220938","DOIUrl":"https://doi.org/10.1055/s-0029-1220938","url":null,"abstract":"<p><strong>Background: </strong>The management of unruptured intracranial aneurysms (UIAs) remains controversial. The International Study of UIAs (ISUIA) found low rates of rupture and appreciable treatment risks. This finding could be interpreted as suggesting that many UIAs should not be treated. Coiling technology has continuously improved over the years and, since the publication of the International Subarachnoid Aneurysm Trial results, increasing numbers of aneurysms have been coiled, and neurointerventional skills have significantly improved. We present the results of endovascular coiling of 131 patients with UIAs from a high volume unit and a risk-benefit analysis based on patient and aneurysm characteristics.</p><p><strong>Patients and methods: </strong>From December 1996 to September 2005, 131 patients (93 women and 38 men, mean age 51 years) with 151 UIAs were treated using detachable coil embolisation. Data on procedural complications, patient and aneurysm characteristics, clinical and radiological follow up were entered into a prospectively collected database. A risk-benefit analysis was performed.</p><p><strong>Findings: </strong>Endovascular treatment was successful in 145 (96 %) aneurysms. One aneurysm ruptured intraoperatively with a fatal outcome. Ten thromboembolic events occurred, leaving one patient moderately disabled. The combined morbidity and mortality rate per patient at 6 months is 1.5 % (95 % confidence interval: 0.07 - 5.7 %). A risk-benefit analysis comparing these data with the published natural history suggests that treatment with low complication rates can be offered to most patients with UIAs.</p><p><strong>Conclusion: </strong>UIAs can be coiled with low morbidity and mortality. The risk-benefit analysis suggests that it is reasonable to off er treatment to patients with the exception of patients over 60 years of age with incidentally found aneurysms less than 7 mm in diameter of the anterior circulation.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1220938","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28749640","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":"Primary extracerebral meningeal glioblastoma: clinical and pathological analysis.","authors":"P Stavrinou,&nbsp;I Magras,&nbsp;L C Stavrinou,&nbsp;T Zaraboukas,&nbsp;K S Polyzoidis,&nbsp;P Selviaridis","doi":"10.1055/s-0029-1225652","DOIUrl":"https://doi.org/10.1055/s-0029-1225652","url":null,"abstract":"Primary meningeal gliomas are uncommon tumors in the subarachnoid space, their primary characteristic being the absence of any obvious connection to the brain parenchyma. Rarely, they are quite malignant and assume a bulky, well circumscribed appearance rendering the differential diagnosis from other CNS neoplasms difficult. A 53-year-old man presented with a history of persistent headaches and left sided weakness. Magnetic resonance imaging revealed a temporoparietal mass attached to the dura that strongly resembled a meningioma. At surgery, the outer layer of the dura mater was intact and there was a clear brain-tumor interface without obvious pial disruption. Histological examination showed a biphasic pattern consisting of benign connective tissue intermingled with bundles of what seemed to be a glioblastoma. The mass demonstrated strong positivity for GFAP and the MIB labeling index focally exceeded 20%. The tumor was identified as a primary meningeal glioblastoma. The patient was disease-free for 42 months, after which he developed a recurrence for which he was re-operated. This time, the pathological findings of the tumor were those of a typical glioblastoma multiforme. We discuss the origin of the initial neoplasm and also the differential diagnosis that needs to include meningioma, aggressive glioblastoma infiltrating the dura and a recently recognized bimorphic CNS tumor: the desmoplastic glioblastoma.","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1225652","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28730096","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":"Anterior cervical discectomy and titanium cage fusion - 7-year follow-up.","authors":"Simone M Rohe,&nbsp;M Engelhardt,&nbsp;A Harders,&nbsp;K Schmieder","doi":"10.1055/s-0029-1220940","DOIUrl":"https://doi.org/10.1055/s-0029-1220940","url":null,"abstract":"<p><strong>Background and study aims: </strong>The purpose of this study was to prospectively evaluate long-term results after anterior cervical discectomy and titanium cage fusion (ACDF) and titanium cage fusion. Special focus was on the adjacent levels.</p><p><strong>Methods: </strong>54 patients (age: 48+/-10 years; one level operation in 44 patients and two level operation in 10 patients) entered the study. Re-evaluation consisted of a clinical out patient investigation and was possible in 33 patients. VAS, PROLO and Oswestry scores were used. Lateral radiographs were taken and changes in the operated and adjacent segments were measured and compared to radiographs directly after surgery. Clinical patient data was compared with the data prior to surgery.</p><p><strong>Results: </strong>The mean follow-up time of the 33 patients was 7.26 +/- 0.22 years. One patient needed re-surgery of the cervical spine above the fused segment. PROLO results showed a significant improvement (PROLO F 1.52+/-0.67 to 3.79+/-1.17 p<0.01; PROLO E 1.52+/-0.5 to 3.55+/-1.42 p<0.01). Mean VAS at the time of investigation was 3.2+/-2.5. Oswestry score was 16.4+/-9.5. The alignment of the whole cervical spine was stable lordotic (Katsuura 10.9+/-9.0 degrees to 11.5+/-7.8 degrees ; p=0.76). Total segmental height had reduced from 36.6+/-4.6 mm to 34.6+/-3.9 mm (p=0.04). No significant reduction of disc space height of adjacent levels was detectable (superior: 5.8+/-1.6 mm to 5.2+/-1.6 mm; inferior: 6.0+/-1.7 mm to 5.3+/-1.9 mm). One adjacent superior level showed spontaneous fusion. Ventral and dorsal osteophytes in the superior and inferior adjacent levels increased in number and increased significantly in degree. Patients with bi-segmental fusion (n=7) showed similar results.</p><p><strong>Conclusion: </strong>ACDF with titanium cages has good clinical long-term results. A significant progression of degenerative changes can be observed on radiographs without clinical consequences for the patients. A comparison with patients without surgery and conservative therapy is needed to allow a better interpretation of the radiological results.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1220940","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28376432","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":"Nonconvulsive status epilepticus as a possible cause of coma in neurosurgical intensive care.","authors":"J Kuchta,&nbsp;N Klug,&nbsp;R-I Ernestus","doi":"10.1055/s-0029-1224168","DOIUrl":"https://doi.org/10.1055/s-0029-1224168","url":null,"abstract":"<p><p>Nonconvulsive status epilepticus (NCSE) can occur in comatose patients without clinical signs of seizure activity. We evaluated the occurrence of NCSE in patients who were admitted to our neurosurgical intensive care unit between 1998 and 2000. EEGs were obtained from 158 patients with head trauma, spontaneous bleeding or brain tumour. Patients with clinically apparent seizure activity or no electrophysiological signs of seizure activity were excluded from the study. Epileptiform activity was seen in 28 out of 158 patients. 11/28 of these patients had a Glasgow-Coma-Scale (GCS) Score below 9 and showed continuous epileptiform discharge without clinical signs of seizure activity (NCSE). The clinical status of 4 of these 11 NCSE patients improved after initiation of anticonvulsive medication. NCSE may be an under-recognised cause of coma in neurosurgical intensive medicine. EEG should be included in the routine evaluation of comatose patients, even if clinical seizure activity is not apparent.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1224168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28082354","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}