Central European Neurosurgery最新文献

{"title":"Radiofrequency neurotomy for headache stemming from the zygapophysial joints C2/3 and C3/4.","authors":"J K Lang,&nbsp;M Buchfelder","doi":"10.1055/s-0029-1224159","DOIUrl":"https://doi.org/10.1055/s-0029-1224159","url":null,"abstract":"<p><strong>Background: </strong>Headaches are a major socio-economic problem, and reliable and effective treatments may have an important economic impact. While many studies have investigated neck pain stemming from the zygapophysial joint, there is little data on the specific problem of headache from the zygapophysial joint C3/4.</p><p><strong>Methods: </strong>In this investigation we included only patients who suffered from chronic headaches which had lasted for at least 12 months and were due to irritation of the zygapophysial joints (facets) of the upper cervical spine. As we aimed to prove the effectiveness of radiofrequency neurotomy in these patients, we had no randomized control group. Patients with the following underlying diseases were included in the study group: cervical fusions (followed by pseudoarthrosis); traumatic cervical fractures (not fused); arthritis.</p><p><strong>Results: </strong>We examined the extent of pain relief on the first day after radiofrequency treatment and the duration of pain relief until recurrence of 50% of pre-coagulation pain in the whole collective and the three subgroups.</p><p><strong>Conclusions: </strong>Our results indicate that this therapy is effective in patients with underlying diseases of primarily degenerative origin. A significant finding was that in the group of patients with arthritis, the duration and extent of pain relief were extremely short compared to the other two groups (p<0.005, U-test).</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-0029-1224159","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28892824","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":"Cages with fixation wings versus cages plus plating for cervical reconstruction after corpectomy - is there any difference?","authors":"M Cabraja,&nbsp;A Abbushi,&nbsp;S Kroppenstedt,&nbsp;C Woiciechowsky","doi":"10.1055/s-0029-1246135","DOIUrl":"https://doi.org/10.1055/s-0029-1246135","url":null,"abstract":"<p><strong>Aim: </strong>Different expandable and non-expandable fusion cages have gained acceptance in spinal surgery. We compared the radiological outcome of titanium cages with mounted wings to cages with additional anterior plating.</p><p><strong>Methods: </strong>We performed a retrospective study of 44 patients after single or two-level cervical corpectomy. For reconstruction of the anterior column two different anterior distraction devices (ADD) were used: cage plus ventral plating (16 cases, ADD group) or cage with fixation wings (28 cases, ADDplus group). Clinical and radiological evaluations were performed after 1 week, 6 months and 12 months. Cervical lordosis, the angle between the adjacent vertebral bodies, the settling ratio, fusion rates, stability, neurological outcome and complications were assessed to compare both groups.</p><p><strong>Results: </strong>Both groups had similar final clinical but different radiological outcomes. The fusion rate was 100% in the ADD group and 89% in the ADDplus group. Furthermore, the relative loss of cervical lordosis after 12 months was higher in the ADDplus group (-6.9% vs. -1.6%). The loss of correction of the relative rotation angle of the operated segment was also higher in the ADDplus group (-4.3 degrees vs. -1.7 degrees). Additional surgery was necessary in three cases in the ADDplus group.</p><p><strong>Conclusions: </strong>This study demonstrates that expandable cages are useful vertebral body replacements, because they can be adjusted to the size of the corpectomy in situ and provide immediate strong anterior column support avoiding bone graft site morbidity. The direct attachment of fixation wings to the cage simplifies the operative procedure but carries a significantly higher risk of non-fusion, loss of lordotic correction and height.</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-0029-1246135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28976579","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":"Giant cell tumor of the frontal bone in an 18-month-old girl: a case report.","authors":"M O Ulu,&nbsp;H Biceroglu,&nbsp;F Ozlen,&nbsp;B Oz,&nbsp;N Gazioglu","doi":"10.1055/s-0029-1243200","DOIUrl":"https://doi.org/10.1055/s-0029-1243200","url":null,"abstract":"<p><strong>Introduction: </strong>Giant cell tumors (GCT) are benign, but locally aggressive primary bone neoplasms, that frequently occur in the epiphyses of the long bones. Less than 1% of all GCTs primarily involve the skull where they are preferentially seen in the sphenoid and temporal bones. In the pediatric age group they are exceptionally rare.</p><p><strong>Case report: </strong>The authors report the management of a GCT involving the frontal bone in an 18-month-old girl. The patient underwent wide surgical excision of the lesion and remains free of clinical and radiological evidence of tumoral recurrence thirty months after treatment.</p><p><strong>Conclusion: </strong>Although rare, GCTs should be taken into consideration as a differential diagnosis of rapidly enlarging cranial mass lesions in pediatric patients. Gross total surgical excision eliminates the potential risks of adjuvant radiotherapy. However, considering the aggressive nature and potential malignancy of these lesions, careful long-term clinical and imaging follow-up is recommended.</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-0029-1243200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28646278","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":"Isolated lympho-histiocytic inflammation of the Gasserian ganglion mimicking trigeminal schwannoma.","authors":"V Tronnier,&nbsp;G Pannier,&nbsp;S Gottschalk,&nbsp;D Petersen,&nbsp;E Reusche,&nbsp;H Merz","doi":"10.1055/s-0029-1237714","DOIUrl":"https://doi.org/10.1055/s-0029-1237714","url":null,"abstract":"<p><strong>Unlabelled: </strong>We present an unusual case of a patient with trigeminal pain and hypesthesia suggesting trigeminal schwannoma, where histology demonstrated an inflammatory lesion of the Gasserian ganglion.</p><p><strong>Clinical presentation: </strong>Patient history and imaging were typical for a trigeminal schwannoma with a dumbbell growth in the middle and posterior fossa. Surgery was performed and resection of a firm mass intermingled with fascicles originating from the ganglion and the mandibular branch was carried out via a subtemporal approach. Histological diagnosis revealed a non-caseating, vaguely granulomatous lymphocyte- and histiocyte-rich inflammation.</p><p><strong>Conclusion: </strong>Inflammatory lesions of the Gasserian ganglion are rare but may mimic tumors. Intraoperative biopsies should be taken prior to complete resection to limit neurological deterioration.</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-0029-1237714","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28892825","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":"Malignant brain oedema after radiosurgery of a medium-sized vestibular schwannoma.","authors":"S Kliesch,&nbsp;S Vogelgesang,&nbsp;R Benecke,&nbsp;G A Horstmann,&nbsp;H W S Schroeder","doi":"10.1055/s-0029-1242728","DOIUrl":"https://doi.org/10.1055/s-0029-1242728","url":null,"abstract":"<p><strong>Case report: </strong>We present a patient with an unusual malignant brain oedema occurring after gamma knife radiosurgery of a medium-sized vestibular schwannoma.</p><p><strong>Clinical presentation: </strong>A 62-year-old female with a large vestibular schwannoma underwent partial microsurgical resection; 6 months later she underwent a second intervention with gamma knife radiosurgery for a medium-sized tumour remnant. With a latency period of 6 months after radiosurgery, she presented with progressive neurological deterioration. Serial magnetic resonance imaging revealed progression of the tumour and of the perifocal oedema which finally extended up to the ipsilateral internal capsule. The patient became comatose.</p><p><strong>Intervention: </strong>The tumour was nearly completely removed via a standard retrosigmoid craniotomy. Histopathological examination demonstrated increased mitotic activity compared to the initial histology. The patient became conscious 10 days after surgery and recovered slowly. Surprisingly, the brain oedema resolved rapidly. The CT scan obtained 11 days after surgery showed almost complete disappearance of the oedema.</p><p><strong>Conclusion: </strong>Although rare, radiosurgery of medium-sized vestibular schwannomas causing brainstem compression may lead to life-threatening tumour progression and malignant brain oedema. Therefore, microsurgical gross total resection should be the preferred treatment option in vestibular schwannomas causing significant brainstem compression.</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-0029-1242728","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28637592","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":"Fusiform aneurysm of the proximal anterior cerebral artery (A1).","authors":"G Mariniello,&nbsp;D Vecchione,&nbsp;G Di Martino,&nbsp;F Briganti,&nbsp;R Donzelli,&nbsp;F Maiuri","doi":"10.1055/s-0029-1202358","DOIUrl":"https://doi.org/10.1055/s-0029-1202358","url":null,"abstract":"<p><strong>Objective: </strong>Fusiform aneurysms of the A1 segment of the anterior cerebral artery (ACA) are exceptional, with only 15 reported cases. This article presents an additional case treated by microsurgical trapping. The aim is to discuss the treatment of these aneurysms based on the aneurysm morphology and the anatomy of the ACA complex.</p><p><strong>Case report: </strong>A 52-year-old woman with subarachnoid hemorrhage (Hunt-Hess grade II) showed an aneurysm of the proximal part of the A1 segment of the left ACA involving the whole circumference of the arterial wall on computerized tomography angiography and digital angiography. There was good collateral blood flow from the right ACA to the distal left ACA. A left pterional craniotomy allowed us to expose a large aneurysm of the proximal part of the A1 segment; the artery entered into the aneurysm sac and could not be identified at the level of the aneurysm. Trapping of the aneurysm was performed with a distal clip placed just before the origin of the artery of Heubner. No neurological deficits were observed postoperatively.</p><p><strong>Conclusion: </strong>Clipping of fusiform aneurysms of the A1 segment using an encircling clip is the treatment of choice but, more often, this is impossible. Trapping of the aneurysm with preservation of the perforating branches (mainly the Heubner artery) may be easily performed when collateral blood flow from the contralateral ACA is sufficient.</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-0029-1202358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28892826","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":"Essentials and pitfalls in the treatment of CNS hemangioblastomas and von Hippel-Lindau disease.","authors":"S Gläsker,&nbsp;J H Klingler,&nbsp;K Müller,&nbsp;C Würtenberger,&nbsp;C Hader,&nbsp;J Zentner,&nbsp;H P H Neumann,&nbsp;V Van Velthoven","doi":"10.1055/s-0029-1234040","DOIUrl":"https://doi.org/10.1055/s-0029-1234040","url":null,"abstract":"<p><p>Hemangioblastomas are rare CNS tumors, which are mostly located in the posterior fossa or spinal cord and occasionally in spinal nerves. They can occur sporadically or as a component tumor of von Hippel-Lindau (VHL) disease, an autosomal dominant tumor syndrome. The limited awareness of several pitfalls in the therapy of these rare lesions results in delayed or suboptimal treatment for many of these patients, especially those with VHL disease. The University of Freiburg serves as a reference center for patients with VHL disease and hemangioblastomas. The current therapeutic strategies for hemangioblastoma patients and typical pitfalls are presented here.</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-0029-1234040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28777308","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":"Haemorrhage from a radiosurgically treated arteriovenous malformation after its angiographically proven obliteration: a case report.","authors":"O Bradác,&nbsp;K Mayeroá,&nbsp;P Hrabal,&nbsp;V Benes","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Small lower-grade Spetzler-Martin arteriovenous malformations (AVMs) are mainly treated by microsurgical resection or stereotactic radiosurgery. The choice of treatment largely depends on the referring centre's preference and the patient's decision. We present here a patient with an AVM repeatedly treated at our Leksell Gamma Knife unit with radiographically confirmed obliteration of the AVM which subsequently began bleeding. This case demonstrates the possibility of late complications in radiosurgically treated AVMs even after their demonstrable obliteration. Meticulous histological examination was performed, proving patency of the AVM nidus. The risk of haemorrhagic complications of radiosurgically removed AVMs despite angiographic proof of their obliteration is, in our view, a cogent argument for preferring surgical resection if the AVM is accessible and for prolonged follow-up after radiosurgical treatment of an AVM.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28984261","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":"Multicentric tumor manifestations of high grade gliomas: independent proliferation or hallmark of extensive disease?","authors":"Martin Hefti,&nbsp;G von Campe,&nbsp;C Schneider,&nbsp;U Roelcke,&nbsp;H Landolt","doi":"10.1055/s-0029-1241190","DOIUrl":"https://doi.org/10.1055/s-0029-1241190","url":null,"abstract":"<p><strong>Objective: </strong>Improvements in microneurosurgical techniques, radiotherapy and chemotherapy for the treatment of high grade gliomas resulted in better local tumor control and longer progression-free survival. Multicentric (MC) lesions located distant from the initial resection area contribute to treatment failure in a growing number of patients. These MC lesions may develop within the course of the disease (metachronous) or may already be present at the time of first tumor manifestation (synchronous). To look for mechanisms and regular patterns behind MC glioma manifestations and to investigate whether they are \"a second primary tumor\" or the result of continuous diffuse glioblastoma cell invasion, we retrospectively analyzed the initial and all follow-up MR studies of our high grade glioma (HGG) patients.</p><p><strong>Patients and methods: </strong>MR studies of 247 consecutive patients treated for HGG at a single institution were analyzed. MC tumor manifestation was defined as more than one gadolinium enhancing lesion within the brain on MRI without a connecting signal alteration in T2 sequences and/or without a connecting hypointense mass in T1 sequences. The minimal distance to define two solitary lesions was set at >10 mm. According to these specifications 40 patients showed MC tumor manifestations in their MR studies on admission or during treatment of their disease. The MR studies of these cases were retrospectively analyzed for patterns in MC tumor manifestation and progression. Topographical specifications and delay in manifestation were used to explain possible pathways of development. Kaplan Meyer survival graphs for metachronous and synchronous MC disease were calculated.</p><p><strong>Results: </strong>24 patients showed MC tumor manifestation at the time of admission. 16 cases developed MC manifestation within a follow-up period of 3-57 months. The location of all lesions could be categorized into one of three distinct patterns (white matter, subependymal, intraventricular). The patterns showed individual and location-specific time gaps to metachronous manifestation. Calculated from the time of first tumor diagnosis, the median survival was longer for patients with metachronous MC lesions (353 days, p<0.05) compared to patients with synchronous MC lesions (110 days) or patients without multicentricity (234 days). Patients with metachronous lesions showed a similar survival (72 days) as patients with synchronous MC lesions (110 days) once they developed MC disease.</p><p><strong>Conclusion: </strong>The topographical patterns and temporal characteristics of MC disease suggest that all manifestations share common mechanisms such as an active migratory process. Our data therefore do not support the concept of an independent MC development of multiple gliomas.</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-0029-1241190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28730095","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":"Confocal neurolasermicroscopy in human brain - perspectives for neurosurgery on a cellular level (including additional comments to this article).","authors":"H-G Schlosser,&nbsp;O Suess,&nbsp;P Vajkoczy,&nbsp;F K H van Landeghem,&nbsp;M Zeitz,&nbsp;C Bojarski","doi":"10.1055/s-0029-1237735","DOIUrl":"https://doi.org/10.1055/s-0029-1237735","url":null,"abstract":"<p><strong>Background: </strong>During neurosurgery intraoperative imaging of vital neural structures on a cellular level would facilitate the development of new strategies for diagnosis and treatment. In vivo imaging would permit the detection of the tumour centre and infiltration zone. With targeted biopsies the lesion of interest could be determined before performing the biopsy, facilitating the final pathological diagnosis. In this study we present confocal neurolasermicroscopy as a new method in neurosurgery.</p><p><strong>Methods: </strong>A miniaturised confocal neurolasermicroscope (NLM) was used ex vivo immediately after tumour resection of glioblastoma multiforme (GBM). NLM was performed with subcellular magnification up to a tissue depth of 100 microm. NLM images were compared to conventional histological images of the same tumour.</p><p><strong>Results: </strong>The application of the method in nine patients allowed adequate diagnosis of a malignant glioma fulfilling the WHO criteria when compared to conventional histology. In one patient with glioblastoma multiforme NLM allowed the correct diagnosis of GBM to be made, demonstrating the high mitotic rate and cell pleomorphy of the tumour cells. Additional characteristics such as pleomorphic cells, mitotic figures, fibrillary matrix and the distinction between tumour centre and infiltration zone could be shown.</p><p><strong>Conclusions: </strong>NLM is a tool which could be adapted for neurosurgical intraoperative applications with the potential to diagnose tumours and recognise the tumour centre and infiltration zone in vivo. Further applications of NLM to characterise subcellular structures and vascular architecture are possible.</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-0029-1237735","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40042182","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}