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Biomedical subjects

H Gumprecht

Publications and source records attributed to H Gumprecht.

11 recordsLinked to original sources
PubMed2003

Neuronavigation combined with electrophysiological monitoring for surgery of lesions in eloquent brain areas in 42 cases: a retrospective comparison of the neurological outcome and the quality of resection with a control group with similar lesions.

The purpose of this study was to achieve a more radical resection of tumors in the area of the motor cortex via minimal craniotomy using a combination of neuronavigation and neurophysiological monitoring with direct electrical cortical stimulation and to compare retrospectively the clinical outcome and postoperative magnetic resonance imaging with a control group that was operated on in our service when the combination of these monitoring techniques was not available. A total of 42 patients with tumors in or near the central region underwent surgery with neuronavigation guidance and neurophysiological monitoring. The primary motor cortex was identified intraoperatively by the somatosensory evoked phase reversal method and direct cortical stimulation. The functional areas were transferred into the neuronavigation system. By stimulating the identified primary motor cortex and displaying the motor area in the operating microscope a permanent control of the motor function was possible during the whole operation. Using these techniques a more radical tumor resection - evaluated by postoperative MRI - was achieved in the study group (p = 0.04) and also a trend toward a better neurological outcome.

Adolescent↗
PubMed2002

Neuronavigation and functional MRI for surgery in patients with lesion in eloquent brain areas.

OBJECTIVE: Surgery in patients with lesions in eloquent areas is still a challenge for the neurosurgeon. The aim of surgical interventions should be the radical removal of the lesions with functional preservation. Functional brain imaging methods provide the preoperative demonstration of those brain areas and their relationship to pathologic structures. MATERIAL: Twenty-seven patients with pathologic lesions in or near eloquent regions were investigated with functional magnetic resonance imaging (fMRI). Nineteen patients were neurologically intact preoperatively, and presented only with headache and/or seizure. Eight patients had a minor neurological deficit. Twenty-five patients underwent surgery. Preoperatively a computed tomography (CT) scan or a magnetic resonance imaging procedure with five skin fiducials was performed. The data were transferred to the neuronavigation workstation. The tumour was lined out in colours, and reconstruction in a triplanar format as well as three-dimensionally was implemented. The information from the fMRI concerning the functional areas was transferred into the images manually to account for EPI distortions. Fifteen patients were operated on using the combination fMRI/neuronavigation. Diagnoses included eleven gliomas, two meningeomas, one metastasis and one cavernoma. RESULTS: In seven patients the tumour was removed completely, eight patients had residual tumour, demonstrated by early postoperative MRI. All patients with residual tumour had gliomas that involved functional areas. Postoperatively no patient had an additional neurological deficit. CONCLUSION: Functional MRI provides important additional information in patients with lesions in eloquent brain areas. In combination with neuronavigation this is a very helpful technique for surgical interventions on these patients to reduce morbidity. Nonetheless, there are still open questions concerning accuracy of display of the functional areas and integration into a neuronavigation system.

Brain↗
PubMed2000

Intraneural growth of a capillary haemangioma of the cauda equina.

Solitary intraneural haemangiomas are very rare. A case of intraneural capillary haemangioma involving two nerve roots of the cauda equina is reported. The patient was a 63-year-old woman with a three years history of intermittent lumbalgia and numbness of the ventral surface of the left thigh. Magnetic resonance imaging detected an intradural extramedullary nodular space occupying mass at the level of the conus medullaris. Laminectomy of T12 and complete removal of the tumour were performed. Histopathological analysis demonstrated a capillary haemangioma. The tumour was located within the sheaths of a spinal nerve root. The lesion consisted of a myriad of small and very small vessels, reticularly arranged with normal nerve fascicles dispersed within the nodules of clustered capillaries. The present case of an intraneural capillary haemangioma of the cauda equina appears to be one of the first reported examples of this entity in the world's literature. The clinical presentation, diagnostic procedures and therapeutic options of intraneural haemangiomas of the conus medullaris and cauda equina are discussed. The current literature is reviewed.

Cauda Equina↗
PubMed2000

Intracerebral paraganglioma.

Paragangliomas of the CNS are relatively rare. Cases of location in the pineal and pituitary glands, cerebellopontine angle, cauda equina and filum terminale are known. In our neurosurgical unit a 42-year-old male patient with a history of vertigo and a generalized seizure underwent an operation for a fronto-temporal tumour. The histological diagnosis was paraganglioma.

Adult↗
PubMed2000

Neuroendoscopy combined with frameless neuronavigation.

Minimal invasive neurosurgery is becoming more and more standard in neurosurgical procedures. Several types of lesions are now approached endoscopically. The surgical planning and intraoperative orientation during endoscopic surgical procedures are sometimes difficult. To solve this problem, a combination of the endoscopic procedure with a frameless, armless neuronavigation system is used in our service. The combination of the endoscope and the frameless navigation system was used in tumour surgery, ventriculostomies and arachnoid cyst operations. All procedures were performed successfully. The combination of both systems has proved to be advantageous because of safe surgical planning using the frameless stereotactic technique and the possibility of real time orientation of the endoscope. This technique is very useful in removing intraventricular and large brain mass lesions.

Arachnoid Cysts↗
PubMed1998

[Multifocal hemangioblastoma in a young woman with Hippel-Lindau syndrome].

A 25 years old female person suffered from v. Hippel-Lindau disease with three manifestations within the central nervous system (cerebellum, nerve root C1 and Medulla oblongata). Pancreatic cysts, a cyst and a tumour of the kidney were diagnosed as well. In a first operation, the large cerebella's tumour and the small haemangioblastoma of the nerve root C1 were removed via a suboccipital craniectomy. A few weeks later, after the patient had made a good recovery, the tumour at the craniocervical junction was removed through a far lateral approach. The postoperative course was without complications. The MRI control seven months after surgery was free of tumour and the young person was in a good clinical condition, without neurological deficit.

Adult↗
PubMed1997

Therapeutic management of grade IV aneurysm patients.

BACKGROUND: The timing of surgery in patients suffering from subarachnoid hemorrhage grade IV and V according to Hunt and Hess, is still controversial. Several authors advocate early surgery for patients in poor clinical condition. Improved outcome and decreased mortality rates were reported. Others exclude patients in poor condition from early aneurysm surgery. METHODS: Forty grade IV aneurysm patients were admitted to our department. After ventriculostomy and cerebral angiography, 28 of them were operated on within 72 hours. The postoperative treatment included hypertensive, hypervolemic, hemodilutional therapy (triple-H therapy) and intensive monitoring (intracerebral pressure, blood pressure, hemodynamic parameters). The mean follow-up time was 6 months. RESULTS: Out of the 28 patients who underwent early surgery, 64% were in good health, 11% in poor health, 25% died; there were no survivors in a vegetative state. Twelve patients were treated conservatively; 50% died from infarction and rebleeding, before the operation was performed. Six underwent delayed aneurysm surgery after clinical improvement. In this group, 25% had good clinical outcome. CONCLUSIONS: Our results favor an aggressive treatment of grade IV aneurysm patients by means of ventricular drainage, early surgery and triple-H therapy.

Critical Care↗
PubMed1996

[Percutaneous puncture tracheostomy in neurosurgical intensive care patients].

In critical care patients requiring prolonged mechanical ventilation, tracheostomy is necessary. Alternatively to the standard surgical method, a percutaneous dilatational technique is available. From September 1993 to October 1994 38 critically ill neurosurgical patients underwent tracheostomy using the minimal invasive puncture method. The patients were aged between 20 and 92 years. The average duration of the tracheostomy was 7.5 [4-15] minutes and was performed bed sided at the ICU. The tracheostomy was controlled endoscopically through the naso- or orotracheal tube. A 8 mm cannula was inserted in each case. One patient died during the procedure of sudden fulminant pulmonary artery embolism. One procedure had to be interrupted because of cardiac failure. In this patient the tracheostomy was performed the day after under optimized conditions. There was no peri- or postoperative bleeding, no pneumothorax, no misplacement of the cannula. An infection of the stoma site was not noticed. The decannulation did not cause any complications (16 cases). The stoma was closed within a few days, only a small scar remained. The bed side procedure of percutaneous dilatational tracheostomy is a safe and quick technique. There is no need to disconnect the patient from intensive monitoring for means of transportation to the surgery room. Thus we find it the method of choice for critically ill neurosurgical patients.

Adult↗
PubMed1994

Expression of interleukin-1 receptor antagonist in human pituitary adenomas in vitro.

The production of cytokines and their receptors in the pituitary gland as well as receptor-mediated cytokine effects on pituitary function have been demonstrated. We have investigated whether the naturally occurring interleukin-1 receptor antagonist (IL-1ra), which has been shown to block IL-1 biological actions during inflammatory processes, could be expressed in human pituitary adenomas (n = 16) cultured in vitro. By polymerase chain reaction of reverse-transcribed RNA we detected IL-1ra messenger RNA in cultures of all types of pituitary adenomas under basal conditions as well as after stimulation of the cells with endotoxin or phorbol myristate acetate. The amplified complementary DNA fragment was identical to the fragment observed when RNA from purified human monocytes was subjected to reverse transcription polymerase chain reaction. In addition, we provide evidence that the IL-1ra messenger RNA detected in human pituitary adenomas corresponds to the intracellular IL-1ra variant. By using specific primers for the monocyte/macrophage marker CD14 as a control, we could exclude a contamination by monocytes or macrophages in the cell cultures of pituitary adenomas as a source of IL-1ra expression. Immunofluorescence studies showed the presence of cellular IL-1ra protein in the pituitary adenoma cultures and the colocalization with hormone-producing cells in GH- and ACTH-secreting adenomas. Production of IL-1ra within the anterior pituitary may act as a protective mechanism, modulating the sensitivity of pituitary cells to circulating or intrinsically produced IL-1 during inflammatory or tumoral processes.

Adenoma↗