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Biomedical subjects

D Stolke

Publications and source records attributed to D Stolke.

At least 73 records · Page 4Linked to original sources
PubMed1994

Microsurgery of the cervical spine in elderly patients. Part 1: Surgery of degenerative disease.

The results of microsurgery for degenerative disease of the cervical spine are reported in 84 consecutive patients being 65 years of age or older at the time of surgery. Patients were suffering from either soft or hard disc disease or from advanced forms of cervical myelopathy. In 60 patients microsurgical resection of the involved cervical disc and posterior osteophytes was performed followed by anterior fusion. Spondylectomy, microsurgical decompression and osteosynthesis was performed in 24 patients with multi-level cervical stenosis. A multitude of accompanying systemic diseases was present in almost all patients. Evaluation of the peri-operative risk profile of the patients was performed using the American Society of Anesthesiology (ASA) Grading of Physical Status Score. In 82 patients a complete follow-up was available. Two patients died within seven days after surgery from heart attack and pulmonary embolism. Three patients died during the observation period from causes unrelated to their cervical disease or to surgery. Overall surgical results were as follows: 66 patients (79%) were improved by surgery, 14 patients (17%) were unchanged, two patients (2%) became worse, and two patients (2%) died. Postoperative recovery was significantly correlated to the pre-operative neurological status. Neither age, nor the pre-operative ASA score had a significant influence on the postoperative outcome. The incidence of peri-operative systemic complications was significantly correlated to the pre-operative physical status of the patients according to the ASA score. No significant correlation towards an increase of peri-operative complications with higher grades of pre-operative neurological deficits or with increasing age of the patients could be found.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Microsurgery of the cervical spine in elderly patients. Part 2: Surgery of malignant tumourous disease.

In this retrospective study, the results of surgery were examined in 25 patients, 65 years of age or older, suffering from malignant tumour growth along the cervical spine. The group consisted of 17 men and 8 women. The mean age was 73 years, ranging from 66 to 88 years. The pathology identified was metastasis in 23 patients, and plasmocytoma in two. The tumour localization involved a single segment of the cervical spine in 12 patients, two segments in 8 patients, three segments in 4 patients, and four segments in one patient. Pre-operatively, 8 patients (32%) suffered solely from severe pain. 6 patients (24%) showed severe pain and radicular nerve compression. 5 patients (20%) had incomplete para- or tetraparesis but were able to walk, and again 6 patients (24%) had incomplete para- or tetraparesis, and were unable to walk. A multitude of accompanying systemic diseases was present in the majority of patients. Evaluation of the peri-operative risk profile was performed using the American Society of Anaesthesiology (ASA) Grading of Physical Status Score. Operation consisted of microsurgical tumour removal, usually incorporating a single- or multi-level vertebrectomy, with radical epidural decompression, and grafting with bone cement followed by an appropriate osteosynthesis. Of the whole cohort of patients treated, four patients were still alive at the time of the last follow-up evaluation. 21 patients died. Four patients died within seven days after surgery. The remaining 17 patients died during the follow-up period. All of these patients died from systemic spread of their primary cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1994

Clinical and radiological evaluation of long-term results of stereotactic proton beam radiosurgery in patients with cerebral arteriovenous malformations.

Within a period of nearly 10 years, from October, 1980, to May, 1990, a total of 68 patients with a cerebral arteriovenous malformation (AVM) were referred to a radiosurgical center in the United States for stereotactic Bragg peak proton beam therapy. Radiosurgery was chosen as an alternative treatment, either because the AVM was considered to be of high surgical risk due to its size and/or location, or because the patient refused surgery. In 63 patients (92.6%), complete clinical and radiological follow-up examinations were available. Clinical and radiological long-term results were correlated to size and to the Spetzler-Martin scale of the AVM. With increasing size or higher grade on the Spetzler-Martin scale, the clinical results of proton beam therapy became progressively worse. Of 37 patients with an AVM between 3 and 6 cm in diameter, only one-third showed amelioration of their clinical symptoms, and two-thirds remained the same or even deteriorated after radiation treatment. The same results apply to patients with very large AVM's, of whom only one-third profited from proton beam therapy. Although 85.7% of the patients in Spetzler-Martin Grades I and II showed postirradiation amelioration of their clinical symptoms, this compares to only 54.2% of the patients in Grade III, and only 24% in Grade IV. In regard to the radiological results of proton beam therapy, complete obliteration during long-term observation was only detectable in 10 patients or 15.9%, which is less than one-sixth of the whole group of 63 patients. All of these obliterated AVM's were smaller than 3 cm. Almost 85% of the patients treated using stereotactic proton beam therapy did not show any angiographic change in the radiological appearance of their AVM. The results reported here indicate that radiosurgery using stereotactic proton beam therapy is ineffective for the treatment of medium- or large-sized AVM's and should not be recommended for patients harboring an AVM larger than 3 cm. If proton beam treatment is contemplated, it should be restricted to AVM's that are less than 3 cm in size and whose location makes them easily accessible only for proton beam therapy.

Adolescent↗
PubMed1993

Advances in diagnosis and treatment of spinal hemangioblastomas.

Spinal hemangioblastoma usually leads to large intramedullary cysts. Until recently clinical and conventional radiological examination was often not able to detect single or multiple tumor niduses at the wall of a secondary syringomyelia cyst. Thus during surgical exploration the tumor not infrequently was missed, leading to misinterpretation of the pathological entity as syringomyelia, spinal gliosis or low grade spinal astrocytoma. This often resulted in explorative biopsy or decompressive laminectomy. Clinical deterioration postoperatively was not uncommon due to the remaining tumor and increasing spinal cord enlargement. Now magnetic resonance imaging allows the exact preoperative localization of the medullary lesion apart from the accompanying cysts and facilitates differential diagnosis of primary syringomyelia or other spinal cord neoplasms. Microsurgical techniques and laser-assisted resection have improved the outcome. We report on eight patients with spinal hemangioblastoma treated in our clinic since the installation of magnetic resonance imaging and laser-assisted microneurosurgery.

Adolescent↗
PubMed1993

Spondylectomy, microsurgical decompression and osteosynthesis in the treatment of complex disorders of the cervical spine.

In 44 patients with complex degenerative, traumatic, neoplastic and infectious disorders of the cervical spine an aggressive surgical approach was used, consisting of spondylectomy, radical microsurgical decompression and osteosynthesis. The patient group consisted of 23 patients with multisegmental cervical spondylosis, 9 patients with primary or metastatic malignant tumour disease spread along the cervical spine, 6 patients with complex cervical trauma and 6 patients with infection affecting one or more cervical segments. Considering the heterogeneity of the group of patients treated, a multitude of neurological symptoms and signs were present. Excruciating pain was the predominant symptom in 84% of the patients, followed by sensory and motor signs of varying degrees in 77% and 65% respectively. Involvement of the long tracts was present in 51%, gait disturbance in 49% and bladder disfunction in 28%. Considering the nature of the underlying disease, in the group with multisegmental cervical spondylosis (MSCS), advanced cervical myelopathy was the predominant clinical symptom, whereas in those patients with trauma, tumour or infection, pain was the leading symptom, followed by disturbed motor and/or sensory function. Altogether 59 vertebrae have been removed in the 44 patients. In 28 patients spondylectomy was performed at one level, in 15 patients at two levels and in one female tumour patient at three levels. In 34 patients an iliac crest bone graft was used and in 10 patients bone cement. Within the observation period, solid fusion was achieved in all patients. In one tumour patient screw loosening was demonstrable at follow-up, but the fusion remained stable. 2 patients with infectious disease required re-operation due to significant loosening of screws and plates. However, after re-stabilization solid fusion was achieved. Considering amelioration of specific pre-operative symptoms and signs, excruciating pain responded best to the stabilizing procedure, with improvement in over 90% of the patients, followed by improvement of sensory and motor deficits in 85% and 82% respectively. Improvement in pre-operative gait disturbance could be achieved in 81% of the patients, while disturbance of bladder function is less likely to improve after surgery with a positive response in only 58%. None of the patients became neurologically worse after surgery. With regard to the underlying disease, patients with MSCS and tumour had the best results with overall improvement in 62% and 75% respectively. While in patients with infection improvement could be achieved in 58%, improvement in trauma patients was demonstrable in only 34% while in 66% the pre-operative clinical status remained unchanged.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

[Radicular paralysis with reference to lumbar root compression syndromes. Incidence, extent and follow-up in a neurosurgical patient sample].

This is a retrospective study of 170 patients which were operated on for lumbar intervertebral disc herniation. The mean follow-up was 8 weeks. All patients showed muscular weakness before operation. Incidence, severity, and natural history of motor deficit following lumbar discectomy are reported. Moreover it was of special interest to analyze the effect of sex, age, severity and duration of muscular weakness, and timing of surgery on changes in radicular function.

Adult↗
PubMed1992

Single intracisternal bolus of recombinant tissue plasminogen activator in patients with aneurysmal subarachnoid hemorrhage: preliminary assessment of efficacy and safety in an open clinical study.

Intracisternal thrombolysis with recombinant tissue plasminogen activator (rtPA) was performed in 20 patients with aneurysmal subarachnoid hemorrhage. All patients had blood accumulations in the basal cisterns according to Fisher's Grade III, thus being at a high risk for the development of posthemorrhagic delayed ischemic deficits (DID). All patients underwent an operation within 72 hours after aneurysm rupture. After the aneurysm had been excluded from the cerebral circulation, a single bolus of 10 mg of rtPA was injected into the basal cisterns. Postoperatively, serial computed tomographic examinations demonstrated radical blood clot removal in all patients. Daily transcranial Doppler examinations revealed accelerated blood flow velocities in 16 of 20 patients. The postoperative results according to the Glasgow Outcome Scale were as follows: 16 patients were Grades I and II, 2 patients were Grade III. Two patients died postoperatively, 1 because of a bowel perforation, and 1 from DID attributable to the development of a cerebral vasospasm. No postoperative bleeding complications occurred. It is concluded that pharmacological removal of subarachnoid blood accumulations can be achieved in a safe and effective way by an intrathecal single bolus of 10 mg of rtPA instilled into the basal cisterns after aneurysm clipping. The acceleration of blood flow velocities in a number of patients indicated that posthemorrhagic arterial narrowing was not completely prevented by this treatment, but this remained asymptomatic in 19 of 20 patients. Although extensive blood clot removal can be achieved by a single bolus of rtPA, more radical or complete blood removal probably requires the use of higher drug concentrations or additional postoperative intracisternal or intraventricular rtPA injections, for which further studies are needed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Cervical intramedullary cavernous angioma with MRI-proven haemorrhages.

Two contrasting cases of cervical intramedullary cavernous angioma in young female patients are reported. One patient had a 3-year course of step-wise progressive tetraparesis; at each of the five events intramedullary bleeding from a cryptic vascular malformation at C6-7 level was diagnosed by MRI. The other patient presented with one episode which led to MRI diagnosis of a vascular malformation at the C2 level. Both patients eventually underwent complete surgical excision of the angioma with subsequent steady improvement of the neurological deficit.

Adult↗
PubMed1991

Cranio-cervical stabilization using contoured luque rectangles.

Cranio-cervical stabilization using preformed Luque rectangles supplemented by autologous bone grafts was performed in 18 patients. Stability at the cranio-cervical junction had been impaired by a number of diseases including rheumatoid arthritis in 12 patients. Metastatic tumour in 5 patients and post-operative swan neck deformity in one patient. In all patients immediate stabilization as well as long-term bony fusion could be achieved, paralleled by improvement of the preoperative neurological condition in differing degrees. Surgery related complications were rare, although, considering the patient population treated, medical and anaesthesiological complications as a result of accompanying diseases may pose serious problems. The technical details of the surgical procedure are described and its application for the treatment of cranio-cervical instability is discussed.

Adult↗
PubMed1991

Effect of intrathecal fibrinolysis on cerebrospinal fluid absorption after experimental subarachnoid hemorrhage.

The effect of intrathecal fibrinolysis on cerebrospinal fluid (CSF) absorption was investigated after experimental subarachnoid hemorrhage (SAH). In 11 cats, SAH was induced by intracisternal application of 1 to 4 ml of fresh autologous blood. Thirty minutes after the experimental SAH, the CSF outflow resistance was found to be elevated from a median of 77 mm Hg/ml/min (range 41.3 to 109 mm Hg/ml/min) to a median of 580 mm Hg/ml/min (range 104 to 7000 mm Hg/ml/min). A logarithmic relationship could be demonstrated between the volume of subarachnoid blood and the elevation of the CSF outflow resistance. The intrathecal application of 2 mg of recombinant tissue plasminogen activator (rt-PA), which is a fibrinolytic substance suitable for lysis of subarachnoid blood clots in man, resulted in an almost total restoration of CSF absorption after experimental SAH. The CSF outflow resistance after SAH was lowered by application of rt-PA from a median of 1028.05 mm Hg/ml/min (range 394 to 7000 mm Hg/ml/min) to 79 mm Hg/ml/min (range 56.7 to 223 mm Hg/ml/min). It is concluded that the impairment of CSF absorption after SAH may play an important role in the pathogenesis of post-hemorrhagic vasospasm.

Animals↗
PubMed1991

Multisegmental cervical spondylosis: treatment by spondylectomy, microsurgical decompression, and osteosynthesis.

Vertebral body replacement after spondylectomy, combined with microsurgical decompression and anterior plating, was performed in 22 patients as an aggressive therapeutic approach to multisegmental cervical spondylosis. The patients were 13 men and 9 women, ranging in age from 32 to 74 years. In 19 patients, the typical signs of cervical myelopathy were present. In three patients, pain was the major symptom, accompanied by moderate spastic paresis and hyperreflexia. Apart from cervical myelography and computed tomographic scanning, which was performed in 10 patients, magnetic resonance imaging was the radiological procedure of choice in 12 patients. During spondylectomy, one vertebra was removed in 14 patients, two vertebrae in seven patients, and three vertebrae in one patient. The time of postoperative follow-up ranged from 8 to 46 months, with an average interval of 21 months. In all 22 patients, satisfactory bony fusion was achieved as demonstrated by radiological control examinations. Seventeen patients (77%) were symptom free or had only minor residual symptoms. Three (14%) patients had intermittent nuchal or cervicobrachial pain, which responded well to analgesic medication or the application of a soft collar. Two (9%) patients still had myelopathic but not incapacitating symptoms. Of 15 patients who were employed before surgery, 13 returned to a full-time job. The only severe complication of surgery was a prevertebral abscess that healed without sequelae. It is concluded that aggressive surgical therapy of multisegmental cervical spondylosis by a combination of vertebrectomy, decompression (using the surgical microscope), bone grafting, and osteosynthesis is a straightforward and promising procedure for the treatment of this debilitating disease.

Adult↗
PubMed1990

Management morbidity and mortality in grade IV and V patients with aneurysmal subarachnoid haemorrhage.

In a retrospective study the clinical management of 74 patients with aneurysmal subarachnoid haemorrhage (SAH) admitted in grade IV and V Hunt and Hess was examined. 39 patients (53%) were admitted within 24 hours after SAH, 29 patients (39%) between 24 and 72 hours after SAH, and 6 patients 8%) later than this time interval. The ruptured aneurysms were located at the anterior communicating artery complex in 34 patients (46%), on the middle cerebral artery in 19 patients (26%), on the internal carotid artery in 12 patients (16%) and at the vertebro-basilar artery complex in 9 patients (12%). In 38 patients (51%) no surgical attack on the aneurysm was performed. 19 (50%) of these patients were in grade IV on admission and 19 (50%) in grade V. In 36 patients (49%) the aneurysm was clipped. Of these patients 29 (81%) were in grade IV and 7 (19%) in grade V. Of the 38 patients in whom no aneurysm surgery was done, 37 patients died, representing a mortality rate of 97%, one patient survived in grade III Glasgow Outcome Scale (GOS). Concerning the outcome in those patients with aneurysm clipping, of 19 patients in grade IV operated on early, 10 patients (53%) made a good recovery, 3 (16%) were left severely disabled and 6 patients (31%) remained in a vegetative state or died. Of the 10 patients in grade IV with delayed surgery 4 (40%) were in grade I and II postoperatively, 2 (20%) in grade III, and again 4 (40%) in grade IV and V GOS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Cerebral perfusion pressure in acute blood pressure decrease with hyperosmolar sorbitol in anesthesia conditions].

Osmotherapy with sorbitol during intracranial surgery caused a significant decrease in arterial blood pressure. It was shown that this sometimes very desirable reaction did not cause relevant decreases in cerebral perfusion pressure, but was on the contrary accompanied by an increase in cerebral perfusion pressure in patients with severely elevated ICP (greater than 30 mmHg). 8 patients were studied by measuring the arterial and intracranial pressure during intraoperative infusions of sorbitol 40% (3 ml/kg body weight). Our findings are explained by the simultaneous decrease in arterial and intracranial pressure. During intracranial surgery sorbitol can be used as the antihypertensive agent of choice for treating hypertensive dysregulation of arterial blood pressure in the initial phase of craniotomy before opening the dura.

Anesthesia, General↗
PubMed1990

[Microsurgery of spinal angioblastoma].

The treatment results of ten patients with spinal hemangioblastoma including clinical, radiological and surgical considerations are reported. Magnetic resonance imaging (MRI) is considered to be the radiological method of choice. With its superior imaging qualities MRI was able to clearly demonstrate the exact anatomical location of the tumor nidus as well as the extent and location of the accompanying space-occupying intramedullary cysts. The tumors could be completely removed in all ten patients using microsurgical techniques. The additional application of the CO2-laser has added significantly to the atraumatic and total tumor extirpation. In none of the patients postoperative worsening occurred. In two patients with long lasting symptoms the pre- and postoperative neurological status was unchanged. Minor sensory sequelae persisted in another two patients. In 6 patients the preoperative neurological deficits including significant motor and sensory disturbances resolved completely. It is concluded that microsurgical removal guided by MRI imaging and aided by the application of laser energy is the method of choice in the treatment of spinal hemangioblastomas.

Adolescent↗
PubMed1990

[Trans-sphenoid microsurgery of craniopharyngioma].

This paper presents the microsurgical transsphenoidal approach to intracranial craniopharygiomas. Essential prerequisites for this route are stressed: enlarged sella, growth into the sphenoid sinus, intact diaphragma sellae. The authors' own material is discussed. It is pointed out that even repeated transsphenoidal decompression of large cystic lesions is well tolerated in elderly patients.

Adult↗
PubMed1990

[Cerebrospinal fluid penetration of ofloxacin (Tarivid) in non-inflamed meninges].

In 9 patients, who underwent lumbar drainage after transsphenoidal surgery for pituitary adenoma, we collected 69 samples of CSF and plasma, respectively. The concentration of ofloxacin was measured bacteriologically. Considering the ofloxacin CSF and plasma levels related to time some aspects of pharmacokinetics are discussed. With maximum CSF concentrations coming up to 40% of plasma levels liquor penetrability is quite good. Ofloxacin seems to be able to prevent (postoperative) meningitis, even with grampositive Cocci.

Adenoma↗
PubMed1990

Acute changes in the dynamics of the cerebrospinal fluid system during experimental subarachnoid hemorrhage.

Early changes in intracranial pressure (ICP), ICP volume index, and resistance to absorption of cerebrospinal fluid induced by experimental subarachnoid hemorrhage were studied in cats. After SAH, the ICP was slightly elevated, and there was a decrease in the buffering capacity of the intracranial space and a sharp rise in outflow resistance. During infusion of blood into the cisterna magna with a constant infusion rate, an extensive increase in ICP could be demonstrated in contrast to the infusion of saline, which caused only slight elevation of ICP. Furthermore, during blood infusion, the ICP level did not reach a plateau phase of pressure, as was demonstrated during infusion of saline. It is suggested that the marked increase in ICP during blood infusion into the subarachnoid space is caused by intracranial volume loading and the simultaneous increase in cerebrospinal fluid outflow resistance. It is concluded that the reported relationship between increased cerebrospinal fluid outflow resistance and increased ICP supports the hypothesis of a strong increase in ICP during subarachnoid hemorrhage in human subjects.

Animals↗