Central European Neurosurgery最新文献

{"title":"IvACT after aneurysm clipping as an alternative to digital subtraction angiography--first experiences.","authors":"D Wachter,&nbsp;M Psychogios,&nbsp;M Knauth,&nbsp;V Rohde","doi":"10.1055/s-0030-1261946","DOIUrl":"https://doi.org/10.1055/s-0030-1261946","url":null,"abstract":"<p><strong>Objective: </strong>After clipping of intracranial aneurysms, digital subtraction angiography (DSA) is recommended for the proof of complete aneurysm occlusion or identification of aneurysm remnants, especially in cases with a more complex angioarchitecture or a difficult operative course. The aim of this study was to evaluate if postoperative intravenous angiographic computed tomography (ivACT) could be a diagnostic alternative in cases of contraindications for DSA.</p><p><strong>Material and methods: </strong>13 patients (12 female, 1 male) underwent surgical clipping of 5 ruptured and 10 innocent aneurysms. Postoperative ivACT was performed in all patients due to refusal or contraindications for DSA.</p><p><strong>Results: </strong>12 patients had almost complete aneurysm clipping, while 1 patient's was incomplete, which was diagnosed by ivACT and confirmed by subsequent postoperative digital subtraction angiography (DSA), which had been accepted by the patient after clarification of the postoperative findings.</p><p><strong>Conclusion: </strong>This study illustrates the efficacy of ivACT for postoperative control of surgically treated aneurysms. The quality of ivACT generated images seems to be sufficient in the detection of residual aneurysms after clipping. In cases with inconclusive results, postoperative DSA should be performed to obtain further details.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1261946","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29199263","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":"Comment to the article: Evidence-based indications for ICP recording after head injury. A review.","authors":"Eckhard Rickels","doi":"10.1055/s-0030-1262809","DOIUrl":"https://doi.org/10.1055/s-0030-1262809","url":null,"abstract":"The statement of the authors of the article “ The evidence based indication for ICP recording after head injury. A review ” is correct, that up to now there is no defi nite proof showing that ICP monitoring improves outcome in traumatic brain injury. The statement, that ICP monitoring is a dangerous procedure, likewise is correct: In the literature the bleeding rate in general is about 5 % . However, the authors did not mention that there is a diff erence between detection of blood near the catheter and a space occupying bleeding, which is much rarer. Furthermore, to take a series in children instead of one in adults to underline the high complication rate is misleading. In addition, the author forgot to mention that this is a procedure in severely ill patients with a high risk of deterioration and death. The absolute majority of procedures in intensive care medicine are accepted but unevaluated by EBM criteria. For good reasons nobody will ever try to proof the benefi t of resuscitation in a double blind randomized study. Artifi cial ventilation, online invasive blood pressure measurement or even normalisation of coagulation disorders and so on, all have a high risk, but are used because the logic behind these procedures is self-evident. The logic and our pathophysiological knowledge of certain diseases will lead to appreciation and judgement between the potential risk and the potential benefi t for the patient. Until we will obtain new insights into brain pathology after trauma, our knowledge today is, that a primary brain injury will start a cascade of secondary brain injuries resulting in brain oedema. According to the Monroe-Kelliedoctrine an increase of volume inside the skull will be followed by an increase of the intracranial pressure, which will cause a decrease of the blood supply, aggravating the risk of secondary damage to the brain. From this point of view it makes sense to know the ICP values. Neurological examination is a quite unreliable monitoring, as it only can be performed in intervals and not online. Since the work of Frohwein we are well aware of the benefi t of artifi cial ventilation in head injury patients. However, for ventilation, sedation is often required which hinders accurate neurological examination. Thus, the recommendation to monitor by clinical examination could sometimes equal to wait for a dilated pupil. However, it should be our goal to prevent that deterioration, and not to react after deterioration. The authors favour the decompressive craniectomy which is an invasive procedure with a rate of complications higher than those of ICP monitoring. Furthermore, decompressive craniectomy is also a procedure which never has shown to improve outcome by EBM criteria. ICP monitoring is mandatory to identify the right moment in which craniectomy is lifesaving and not a needless operation. In conclusion, it is correct that there is no proof of the eff ect of ICP monitoring. But it makes sense to obtain as many informati","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1262809","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29199264","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":"Ossified chronic subdural hematoma.","authors":"M Turgut,&nbsp;H Samancoğlu,&nbsp;Y Ozsunar,&nbsp;M Erkuş","doi":"10.1055/s-0030-1253346","DOIUrl":"https://doi.org/10.1055/s-0030-1253346","url":null,"abstract":"Turgut M et al. Ossifi ed Chronic Subdural Hematoma. Cen Eur Neurosurg 2010; 71: 146 – 148 Introduction ▼ Calcifi cation of chronic subdural hematoma or cephalhematoma has been reported on several occasions in the literature. Nevertheless, ossifi ed chronic subdural hematomas have been reported only rarely [2, 6, 7, 9, 15, 24] . In this report, we present a case of a 30-year-old woman with chronic subdural hematoma that was seen to be aff ected by a giant crustlike ossifi cation, which was successfully excised.","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1253346","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28962309","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":"Current concepts in perioperative care for the prevention of deep surgical site infections in elective spinal surgery.","authors":"D Meyer,&nbsp;R Klarenbeek,&nbsp;F Meyer","doi":"10.1055/s-0029-1224194","DOIUrl":"https://doi.org/10.1055/s-0029-1224194","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative deep wound infections are the third most common reason for nosocomial infections after pneumonia and urinary tract infections. Deep wound infections lead to higher rates of morbidity and mortality and increased costs of treatment. Infection rates following spinal surgery are reported to lie between 1.9 and 10%. This study was carried out to prove whether a new internal concept for perioperative management could reduce the infection rates following spinal surgery.</p><p><strong>Methods: </strong>Based on the current literature we developed a concept for perioperative care in spinal surgery in order to prevent postoperative deep wound infections. We retrospectively compared infection rates of 2006 and 2007 after the implementation of our perioperative care concept in spinal surgery patients. Total annual operations were comparable.</p><p><strong>Results: </strong>After the introduction of our predominantly evidence-based concept of perioperative care for spinal surgery patients, we found a considerable decrease in infection rates from 0.6% in 2006 to 0% in 2007.</p><p><strong>Conclusion: </strong>A new concept for perioperative care in spinal surgery for the prevention of deep wound infections was found to effectively reduce infection rates. Due to the limitations of our single-center retrospectively selected cohort, further research is necessary to support our results.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1224194","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28749924","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":"Interdural epidermoid of the cavernous sinus.","authors":"K Ghaemi,&nbsp;M J Mirzayan,&nbsp;J K Krauss","doi":"10.1055/s-0029-1224169","DOIUrl":"https://doi.org/10.1055/s-0029-1224169","url":null,"abstract":"Ghaemi K et al. Interdural Epidermoid Tumor ... Cen Eur Neurosurg 2010; 71: 155 – 156 Introduction & Epidermoids account for 0.3 – 1.8 % of all intracranial space-occupying lesions [4, 6, 18] . Most of these tumors are located in the cerebellopontine angle, but they may occur at any site within the cranial cavity [15] . Rarely, they may be found in the cavernous sinus, and an unusual variant is occurrence within the lateral dural layers of the cavernous sinus [2, 6] . To the best of our knowledge, the isolated manifestation of an oculomotor palsy has not been reported previously in this context. Here we report on the management and the postoperative course after removal of an epidermoid between the dural layers of the lateral wall of the cavernous sinus.","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1224169","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28888198","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":"True posterior communicating artery aneurysm associated with arteriovenous malformation: first report and literature review with special focus on flow alterations.","authors":"O Celik,&nbsp;R Kivisaari,&nbsp;J Kokuzawa,&nbsp;R Dashti,&nbsp;O Navratil,&nbsp;R Romani,&nbsp;M Niemela,&nbsp;J Hernesniemi","doi":"10.1055/s-0029-1225327","DOIUrl":"https://doi.org/10.1055/s-0029-1225327","url":null,"abstract":"Introduction & True posterior communicating artery (PCoA) aneurysms represent extremely rare lesions, the precise frequency of which remains unknown. These aneurysms are located on the trunk of the PCoA and should be diff erentiated from common aneurysms, which involve the origin of the PCoA from the internal carotid artery (ICA). However, diagnosis of these aneurysms is diffi cult when they are located close to the ICA. In some of the previously reported cases, the correct diagnosis was only achieved during surgery [15, 17, 19, 38, 40] . Three dimensional (3D) reconstructions of digital substraction angiography (DSA) and / or computed tomography angiography (CTA) are needed for optimal preoperative evaluation and surgical treatment of these lesions.","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1225327","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28928281","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":"Glioblastoma invasion, cathepsin B, and the potential for both to be inhibited by auranofin, an old anti-rheumatoid arthritis drug.","authors":"R E Kast","doi":"10.1055/s-0029-1242756","DOIUrl":"https://doi.org/10.1055/s-0029-1242756","url":null,"abstract":"Cathepsin B activity is absent in normal brain tissue but overexpressed in glioblastomas. Immunohistochemistry localizes cathepsin B to areas of invasion and neovascularization. Several research teams have confirmed the relationship between higher cathepsin B expression, more aggressive glioblastoma course and a shorter overall survival. An old anti-rheumatoid arthritis drug, auranofin, has a documented micromolar range for the inhibition of cathepsin B. Such levels are clinically achievable with the adequately tolerated doses that are used to treat rheumatoid arthritis. The side-effect profile of auranofin, although not entirely problem-free, is benign enough to warrant further trials in good fidelity rodent glioblastoma models followed by a translation to clinical trials if these confirm a potential for benefit. A newly discovered amplification loop between cathepsin B and urokinase-type plasminogen activator outlined in this paper is active in glioblastoma and makes auranofin inhibition particularly attractive for its potential to inhibit the matrix degrading feedback cycle.","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1242756","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28691624","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":"Influence of blood pressure variability on short-term outcome in patients with subarachnoid hemorrhage.","authors":"K Beseoglu,&nbsp;K Unfrau,&nbsp;H J Steiger,&nbsp;D Hänggi","doi":"10.1055/s-0029-1237725","DOIUrl":"https://doi.org/10.1055/s-0029-1237725","url":null,"abstract":"<p><strong>Objective: </strong>Several recent investigations have demonstrated a significant influence of blood pressure variation during the immediate period after stroke. The present study was conducted to evaluate the effect of blood pressure, intracranial pressure and cerebral perfusion pressure variation on short-term outcome in patients after severe subarachnoid hemorrhage (SAH).</p><p><strong>Material and methods: </strong>105 patients suffering from severe SAH were included in the study. The Glasgow Coma Scale (GCS) Score and World Federation of Neurological Surgeons (WFNS) grading were used to describe the patients on admission, and the short-term outcome was assessed using the GCS and the Glasgow Outcome Scale (GOS) Score. In all patients, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were continuously recorded. For each recorded parameter (SBP, DBP, MAP, ICP and CPP) the first recorded value was defined as the baseline value (bas). The minimum (min), maximum (max) and average (mean) value was identified from all recorded values for each parameter and the range between minimum and maximum value was calculated (range). Based on the individual parameter range (absolute values) the variability of successive values was determined as the successive variation (sv). Finally, the values obtained were correlated to clinical outcome and analyzed statistically.</p><p><strong>Results: </strong>In 105 patients the database offered an average of 330.4 single readings (median 318). SBPmax, and SBPrange were significantly lower in the group with an improving short-term GCS than in the group with constant or deteriorating GCS ( P=0.0079 and P=0.0006, respectively). SBPmin was significantly higher in the improved GCS group (P=0.0235). With regard to successive variation (SBPsv) we could not demonstrate a significant difference between both groups (mean SBPsv 15.7 vs. 14.7; P=0.1223), and no correlation with either GCS at discharge (P=0.91) or GOS at discharge (P=0.841) was detectable. There was no statistically significant difference in CPP and ICP between both outcome groups.</p><p><strong>Conclusion: </strong>Systolic blood pressure levels and range appear to be of importance for the management of patients suffering from SAH and may influence patient outcome.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1237725","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28925474","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":"Poly-axial screw removal.","authors":"A Ulus,&nbsp;A H Kaya,&nbsp;Y Bayri,&nbsp;A Dagcinar,&nbsp;H Sataloglu,&nbsp;A Senel","doi":"10.1055/s-0029-1246139","DOIUrl":"https://doi.org/10.1055/s-0029-1246139","url":null,"abstract":"<p><p>As the use of instrumentation in spinal surgery has become common, the need for revision surgery has increased. During revision surgery one of the most difficult steps is removal of poly-axial pedicle screws, especially if no suitable revision set is available. We describe here an easy method for poly-axial screw removal. Leaving or placing a small piece of rod, attached firmly by a nut, tightens the head of the poly-axial screw. It can no longer move freely from the distal part of the screw and the screw can be removed by turning it counterclockwise with a big clamp or needle driver, which is available in almost every surgery set.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1246139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28696990","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":"Surgical technique and validation of outcome assessment in sagittal synostosis.","authors":"T Psaras,&nbsp;M U Schuhmann,&nbsp;T Bottler,&nbsp;M Krimmel,&nbsp;M Wolff,&nbsp;J B Honegger,&nbsp;B E Will","doi":"10.1055/s-0029-1220714","DOIUrl":"https://doi.org/10.1055/s-0029-1220714","url":null,"abstract":"<p><strong>Background: </strong>Aim of the study was to evaluate the outcome of children operated for sagittal synostosis, with special attention paid to the postoperative aesthetic result, as seen from the parents' and the treating medical doctors' perspective, and to assess the time point for operative correction.</p><p><strong>Methods: </strong>A retrospective chart review of 87 patients operated over 15 years was performed. Data included age at the time of operation, perioperative complications, duration of hospital stay, intraoperative blood loss, transfusion volume, neurological outcome, and postoperative skull growth. Aesthetic outcome was assessed at 6, 12 and 18 months after surgery separately by the treating medical team and the children's parents.</p><p><strong>Results: </strong>Sagittal synostosis was diagnosed in 98.9% of cases in the first six months of life. We performed the same operative technique in all children with bilateral total removal of parietal bones. The median age at operation was 5 months. There was no correlation between age at the time of operation and blood loss (p<0.602). 5.7% of the children presented with significant postoperative skull asymmetries. All of these children had undergone operation in the first four months of life (p<0.01). The evaluation of the postoperative aesthetic outcome as seen by parents and doctors was highly convergent, with 79.3% of children in the excellent or good outcome group</p><p><strong>Conclusions: </strong>Our results suggest that the feasible time period for the method used by us is around the 5th - 6th month of life, with satisfying results. With regard to the aesthetic outcome assessment we recommend our approach using validation by parents as a valuable new principle.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1220714","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28646279","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}