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Biomedical subjects

H Fankhauser

Publications and source records attributed to H Fankhauser.

At least 55 records · Page 3Linked to original sources
PubMed1991

Computed tomography of the postoperative intervertebral disc and lumbar spinal canal: serial long-term investigation in 19 patients after successful operation for lumbar disc herniation.

The first part of this work, published in 1988, included 25 patients who had computed tomographic (CT) scans without contrast enhancement and plain x-rays of the lumbar spine before, 1 week after, and 6 to 7 weeks after a successful operation for lumbar disc herniation. The present study extends the follow-up period to 3 years in 19 of the 25 original patients. Clinical examinations, lateral plain x-rays, and CT scans without contrast enhancement of the operated disc were repeated. The results indicate a decrease or even a disappearance of the hyperdense extradural material thought to represent fibrosis. An image suggestive of persistent disc herniation was still present in 5 of 8 patients with this finding on early postoperative CT scans. Persistent intradiscal gas was seen in nearly half of the patients. Total normalization of the posterior extraspinal structures was the rule. There was no correlation between CT appearance and residual complaints of the patients. CT scans without contrast enhancement may be sufficient to guide the surgeon in postoperative patients with massive signs and symptoms of recurrent root compression in whom a second operation is indicated on clinical grounds. In all other cases, myelography followed by CT scans is considered appropriate to investigate failed back surgery syndrome.

Adipose Tissue↗
PubMed1991

Arteriovenous malformation in meningothelial meningioma: case report.

An unusual association of a meningioma and an arteriovenous malformation is reported. A 68-year-old man developed left homonymous hemianopsia, left hemiparesis, and gaze palsy. Magnetic resonance imaging showed a right occipital mass lesion containing multiple signal-void areas with tubular and honeycomb appearance, suggesting a marked vascular component. An angiogram showed abnormal vasculature in the mass supplied by the posterior cerebral artery and a dural arteriovenous malformation on the tentorium. Neuropathological examination after total removal of the mass revealed a meningothelial meningioma including major portions of an arteriovenous malformation that extended from the dura and leptomeninges, through the meningioma, and into the occipital lobe, where the tumor was located.

Aged↗
PubMed1990

Development of a new microsurgical robot for stereotactic neurosurgery.

The robot technology was introduced into a new stereotactic neurosurgery system for applications to biopsy, blind surgery, and functional neurosurgery. The authors have developed a newly designed prototype microsurgical robot, designed to allow a biopsy needle to reach the target such as a cerebral tumor within a brain automatically on the basis of the X, Y, and Z coordinates obtained by CT scanner. This robot is so small that it can be driven in a CT scanner gantry. It consists mainly of the link mechanism and the insertion mechanism. We constructed the link mechanism and investigated its working space.

Biopsy, Needle↗
PubMed1990

Configuration of a robot dedicated to stereotactic surgery.

The design of a robot for functional stereotactic surgery which is under construction in our laboratory is described. The main features include operation inside the computed tomographic (CT) scanner, the possibility of intraoperative CT scanning and complete handling of the stereotactic probes by the robot.

Brain Diseases↗
PubMed1989

Unusual presentation of thoracic disc herniation.

A 24-year-old patient with thoracic disc herniation mimicking lumbar disc disease is reported. While getting out of his car the patient suffered an acute onset of lumbar pain radiating down to the buttock and vaguely into the abdomen on the right. Myelography and computed tomography demonstrated a centrolateral noncalcified disc herniation at T10-11, in close relation to a Schmorl's node. The different clinical presentations of thoracic disc herniation are discussed.

Adult↗
PubMed1989

Effect of three pretreatment techniques on hemodynamic and CSFP responses to skull-pin head-holder application during thiopentone/isoflurane or propofol anesthesia.

The effects of three different pretreatment techniques on ICP and MAP responses to pin head-holder application (HH) were studied. Thirty-two patients for elective intracranial surgery were assigned randomly to three pre-treatment groups: group I-local scalp infiltration with lidocaine (6-8 ml of 2% solution); group II-deepening of general anesthesia with either thiopentone (2 mg/kg) or propofol (0.6 mg/kg); and group III-intravenous fentanyl (4 mug/kg). Two anesthetic techniques were used, subdividing the three groups into subgroup A (thiopentone-isoflurane) and subgroup B (propofol). Measurements of MAP, cerebrospinal fluid pressure (CSFP), cerebral perfusion pressure (CPP), and heart rate (HR) were made at pretreatment, just before HH (time T0: baseline), and 0.5, 1, 2, 3, 4, and 5 min after HH. Within each group, MAP, HR, CPP, and CSFP varied similarly in both subgroups, so the data from A and B were cumulated. After HH application, MAP, HR, CPP, and CSFP increased in all groups, but significantly less in group I. The maximal MAP increase occurred at T1 and was 6.7 +/- 2.2% in group I, 27.9 +/- 4.9% in group II, and 27.1 +/- 6.5% in group III (difference between I and II-III: p <0.005). HR increased similarly in the three groups, but less in group I. The maximal CSFP increase occurred at T0.5 and was 12.2 +/- 10.0% in group I, 31.9 +/- 10.8% in group II, and 24.5 +/- 5.6% in group III (difference between I and II-III: p < -0.05). The changes in CPP paralleled MAP changes. In conclusion, the thiopentone-isoflurane sequence and continuous propofol anesthesia provide similar hemodynamic conditions and responses to nociceptive stimuli; local lidocaine infiltration achieves better control of MAP, HR, CSFP, and CPP after HH application than the deepening of general anesthesia or intravenous fentanyl.

Journal Article↗
PubMed1988

[Normal-pressure hydrocephalus in adults. Analysis of results and complications following ventriculo-cardiac derivation].

The results of ventriculo-atrial shunting have been analyzed in 37 patients with normal pressure hydrocephalus. The nature and severity of the symptoms and their progression in time, together with the results of computed tomography and clinical response to CSF withdrawal by lumbar puncture, were compared with the outcome after shunting, in order to define reliable prognostic criteria. In the long term, 43% of the patients improved and 30% died. The complication rate was 22%, including primarily subdural hematoma and shunt malfunction. Amongst the symptoms, ataxia responded best to shunting. Clinical improvement after subtraction of lumbar CSF, and demonstration by computed tomography of ventricular dilation with a hypodense area around the frontal horns in the absence of cortical atrophy, were associated with a favorable outcome.

Aged↗
PubMed1988

Computed tomography of the postoperative intervertebral disc and lumbar spinal canal: investigation of twenty-five patients after successful operation for lumbar disc herniation.

Twenty-five patients with good outcome after operation for lumbar disc herniation underwent unenhanced computed tomography (CT) and plain radiography of the lumbar spine before, 5 to 7 days after, and 6 to 7 weeks after the operation to define the radiological features of the postoperative disc and spinal canal. After operation, the center of the disc appears hypodense. The anterior and lateral borders remain sharply delimited, but in 44% of the cases the posterior border shows an image suggesting the persistence of disc herniation. In 84% of the cases, there are major changes in the spinal canal with complete occlusion of the extradural space on the operated side by a heterogeneous material the attenuation value of which ranged between those of cerebrospinal fluid and disc. The outline of the dural sac and of the nerve root is lost. This aspect did not significantly change between the 1st and the 6th postoperative week, except for the disappearance of any air within the canal and a slight movement on the dural sac toward the operated side. From these major radiological modifications found in asymptomatic postoperative patients, it is concluded that positive CT in patients with the failed back surgery syndrome has limited value. Myelography is preferred as the primary neuroradiological investigation.

Adult↗
PubMed1988

[The herniated disk].

Explore the source record for details and available documents.

Combined Modality Therapy↗
PubMed1987

Extreme lateral lumbar disc herniation.

Extreme lateral lumbar disc herniation (ELLDH) occurring into and/or outside the intervertebral foramen was encountered in 95 cases amongst 1600 operations for herniated lumbar disc (6%): 43% occurred at L5-S1, 38% at L4-5, 18% at L3-4, and 1% at L2-3. The incidence amongst all herniations at one particular level was 6% at L5-S1, 4% at L4-5, and 18% at L3-4. The clinical presentation varied according to the level of extreme lateral disc herniation, but was not different from the presentation of a classical paramedian herniation occurring one level above. Forty-three patients were investigated with computed tomography (CT) only, 2 with myelography only, and 50 with both. CT always clearly demonstrated the pathology, but some cases are presented to illustrate the differential diagnosis. Myelography was normal in 13 cases; in 27 cases it showed a typical shortening and enlargement of the nerve root sheath which enters the affected intervertebral foramen. At operation, a total facetectomy was performed in 52 patients, a partial facetectomy in 34, and a lateral approach to the intervertebral foramen in 9. The lateral approaches, either paramuscular with retraction of the paraspinal muscles from the midline, or transmuscular by splitting of the paraspinal muscles, are described and illustrated in detail.

Adult↗
PubMed1986

Computed tomography in spinal hemangioma with cord compression. Report of two cases.

Two teenagers with spinal cord compression due to a thoracic vertebral hemangioma are presented. Myelography showed a complete block in both patients. Selective intercostal arteriography was normal or non-conclusive. Only computed tomography (CT) gave precise information about the extent and nature of the compressive lesion. In the first case it showed angiomatous involvement of the body and all parts of the neural arch of T4, and a posterior epidural ossified angiomatous mass. In the second case it showed angiomatous involvement of the vertebral body and an anterior extradural soft tissue mass; this latter was considered to represent a resolving extradural hematoma. CT, preferably performed after intrathecal contrast injection, is the diagnostic procedure of choice for spinal hemangioma with cord involvement.

Adolescent↗
PubMed1986

[The best neuroradiological test in the preoperative investigation of lumbar sciatica. The neurosurgeon's point of view].

A short review of the theoretical and practical performance of myelography and computed tomography in the investigation of sciatica is presented. It is concluded that at the present time, myelography remains the primary procedure except in cases of typical, acute sciatica with involvement of a single root where computed tomography can be preferred under certain conditions.

Back Pain↗
PubMed1986

[Reoperation after treatment of a disk hernia. Comparison between radiology and surgical findings in 18 cases].

Eighteen patients with recurrent sciatica after lumbar disc surgery were investigated by both, myelography and computed tomography (CT) before reoperation. The radiological diagnosis according to the original x-ray report was correlated with the surgical findings at reoperation. Myelography reports describe morphological changes but often contain no definite diagnosis. CT reports usually contain detailed tissue diagnosis, but correlation with surgical findings is generally poor. Review of the original x-ray films leads to the following conclusions: At present, myelography is always indicated, except in suspected extreme lateral disc herniation. CT should be reserved for particular clinical or myelographic problems.

Humans↗
PubMed1986

[Extreme lateral lumbar disk herniation. Apropos of a series of 25 cases].

Twenty-five cases of extreme lateral disc herniation (ELDH) were identified amongst 680 operated lumbar discs (3.7%). Their anatomical, radiological and clinical features are presented. They were found at all levels between L3 and S1. At the L5-S1 level 12 ELDH occurred amongst 253 disc herniations (5%), at the L4-L5 level, 8 ELDH amongst 400 herniations (2%), and at the L3-L4 level, 5 ELDH amongst 21 herniations (24%). No clinical features were encountered which could allow to differentiate between an ELDH and a classical disc herniation of the above level. Twenty-three patients underwent lumbar myelogram. This was normal in 6. In 12 it showed a slight shortening and widening of the above situated nerve root sleeve. The same abnormality can be found with downward migration of a classical herniation of the above situated disc or with a lateral recess stenosis. Twenty-five patients underwent computed tomography (CT.). In 24, the ELDH could be unequivocally identified. Disc material occupied the intervertebral foramen or the extravertebral space just beyond it, replacing the normal fat. In order to identify an ELDH, CT has to be done whenever myelogram is normal or equivocal. If the patient is to be investigated by CT only, slices through the intervertebral foramen and the disc below the clinically suspicious level have to be included. Operation in all cases consisted in total or partial unilateral laminectomy with facetectomy.

Adult↗