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Biomedical subjects

J M Gilsbach

Publications and source records attributed to J M Gilsbach.

At least 127 records · Page 7Linked to original sources
PubMed1995

Planning and surgical strategies for early management of vertebral artery and vertebrobasilar junction aneurysms.

Selection of the approach and technique for surgical repair of aneurysm of the vertebrobasilar artery system is mainly based on angiographic features. This report emphasizes that planning the surgical procedure should also include preoperative evaluation of the individual skull base configuration, as well as the relationship between aneurysm site and surrounding bony structures. These features are evaluated on thin slice CT scans using bone tissue algorithms and are particularly important for adequate exposure of distal vertebral artery (VA) or midline aneurysms, because these cases require drilling of the jugular tubercle. For the use of lateral approaches, the surgeon must be familiar with the extradural and intradural anatomy of the foramen magnum region and may rely on at least five anatomical landmarks for orientation during surgery: 1) the dural entrance of the vertebral artery; 2) the posterior condylar emissary vein; 3) the medial rim of the distal sigmoid sinus; 4) the hypoglossal canal; 5) the jugular tubercle. To increase the safety of the procedure, the authors recommend an individualized tailoring of the surgical approach according to the variable morphological situation of each patient.

Arteries↗
PubMed1995

Spinal dural arteriovenous fistulas: a plea for neurosurgical treatment.

Spinal dural arteriovenous fistulas are the most common type of arteriovenous malformation involving the spinal cord, especially in middle-aged men. We report 21 patients with this malformation who had signs and symptoms of myelopathy. The diagnosis was established by selective spinal angiography in patients whose neurological deficits, myelograms or magnetic resonance tomographies suggested the presence of a spinal arteriovenous fistula. They were treated by microsurgical coagulation of the fistula nidus located in the dura and intradural division of the draining vein. Twenty patients improved neurologically following surgery, one remained unchanged. Complete obliteration of all lesions was verified by intra-operative microvascular Doppler sonography and in 3 cases by postoperative angiography. There were only a few minor and transient complications after surgery: one neurological deterioration where venous thrombosis was suspected, one cerebrospinal fluid accumulation and, in one case a transient wound healing impairment. Two patients had to be operated on again. In one case with difficult localization of a fistula at the L5/S1 level, the fistula was still visible in the postoperative angiogram. In another patient, a spinal epidural haematoma occurred a few hours after surgery. We conclude that microsurgical treatment of spinal dural arteriovenous fistulas is a safe, fast, simple and effective method of treating these lesions. However, recovery after surgical management was often incomplete because the diagnosis was established too late and the patient already presented with severe and long-lasting deficit. Thus, the main problem remains a diagnostic and not a surgical one.

Adult↗
PubMed1995

Monosomy 1p is correlated with enhanced in vivo glucose metabolism in meningiomas.

The 2-[18F]fluoro-2-deoxy-D-glucose (FDG) uptake of 25 human meningiomas was preoperatively evaluated in vivo by positron-emission tomography (PET). After surgery, meningioma biopsies were analyzed cytogenetically. Five meningiomas showed partial monosomy for chromosome 1p additional to other typical chromosome aberrations. This aberrant karyotype was correlated with increased FDG uptake. Three of five meningiomas with monosomy 1p were classified as grade II according to WHO, while only one of 20 tumors without monosomy 1p was classified as grade II. Thus, monosomy 1p and elevated FDG uptake in PET are to be regarded as cytogenetic and metabolic parameters for the aggressiveness of meningiomas.

Adult↗
PubMed1995

Frameless neuronavigation in modern neurosurgery.

A fundamental effort in neurosurgery is to reduce surgical trauma. Microneurosurgical technique combined with precise localization of lesions, can minimize the invasiveness of neurosurgical procedures. This report summarizes the utility of frameless neuronavigator systems and examines their value in reducing operative invasiveness. The basic principle of neuronavigation is the virtual linkage between digitized neuroradiological data and real anatomical structures, allowing an excellent three-dimensional orientation by real-time graphic-anatomic interaction. As frameless graphic interactive neuronavigation is developed further, these devices should become an important component of the modern microneurosurgical armamentarium and reduce surgical morbidity.

Humans↗
PubMed1995

Introspective capacities in patients with cognitive deficits after subarachnoid hemorrhage.

Examined 58 patients after subarachnoid hemorrhage by means of neuropsychological tests, a self-report questionnaire, proxy ratings, and personality forms. The degree of cognitive impairment showed only a slight association with an impairment self-rating scale (r = .32, p > .01). On the other hand, the proxy impairment ratings correlated well with the degree of cognitive disturbance (r = .68, p < .001). Self-rated impairment correlated substantially with depression (r = .63, p < .001). A 2 x 2 analysis of variance showed a significant two-way interaction (p = .014) between depression and cognitive disturbance explaining the subjective impairment rating. Depressive patients tended to maximize their actual degree of impairment. Patients with right parietal and/or frontal infarcts showed significantly less depression and illness concern than did patients with infarcts at other locations, although both groups had a comparable degree of cognitive and self-rated impairment.

Activities of Daily Living↗
PubMed1995

Quality of life and cognitive deficits after subarachnoid haemorrhage.

In a retrospective study of 58 patients after subarachnoid haemorrhage (SAH) with a late result either good (GOS = I) or fair (GOS = II), patients were examined 1-5 years after the acute event for their quality of life including a neuropsychological examination. Cognitive deficits were found in visual short-term memory (46%) and in the three parameters of a reaction-time task ranging from 31 to 65%. Further deficits were found in verbal long-term memory (28%), concentration (5-13%) and language (11%). The quality of life was reduced in the SAH patients according to a self-rating scale in motivation (50%), interests (47%), mental capacity (47%), free-time activities (52%), social relationships (39%), concentration (70%), fine motor co-ordination (25%) and sleep (47%). A further 77% of the patients reported more frequent headaches since their SAH. Depression was found in 30% of the SAH patients. Life-satisfaction was significantly reduced in 37%, whereas 48% of the SAH patients suffered from increased emotional lability and in 41% motivation was significantly reduced. Negative job consequences like loss of job or demotion were reported by 16% of the patients investigated and an additional 15% had been retired.

Activities of Daily Living↗
PubMed1994

Three-dimensional spiral CT for neurosurgical planning.

We carried out 22 examinations to determine the value of three-dimensional (3D) volumetric CT (spiral CT) for planning neurosurgical procedures. All examinations were carried out on a of the first generation spiral CT. A tube model was used to investigate the influence of different parameter settings. Bolus injection of nonionic contrast medium was used when vessels or strongly enhancing tumours were to be delineated. 3D reconstructions were carried out using the integrated 3D software of the scanner. We found a table feed of 3 mm/s with a slice thickness of 2 mm and an increment of 1 mm to be suitable for most purposes. For larger regions of interest a table feed of 5 mm was the maximum which could be used without blurring of the 3D images. Particular advantages of 3D reconstructed spiral scanning were seen in the planning of approaches to the lower clivus, acquired or congenital bony abnormalities and when the relationship between vessels, tumour and bone was important.

Adult↗
PubMed1994

Ultrasound-guided craniotomy for minimally invasive exposure of cerebral convexity lesions.

The authors describe a method of real-time ultrasound-guided craniotomy for an approach to cerebral convexity lesions. During surgery, a specially designed high frequency (7.5 MHz) sector probe with a thin (11 mm), extended tip is used to image the cerebral lesion through a single burr-hole. The distance between burr-hole and lesion and the direction of the target are then determined from the ultrasound images, and craniotomy is completed with the aid of these parameters. Errors in the preoperative planning of the approach, which might result in incorrect placement of the craniotomy, can easily be recognized and corrected at an early stage of the operation, before the craniotomy has been completed. This technique greatly improves the accuracy in placing craniotomy flaps. Since the risk of misplacing the craniotomy is virtually eliminated in lesions which are identifiable on ultrasound images, the technique allows the surgeon to keep the skull opening as limited as possible.

Brain Neoplasms↗
PubMed1994

Is there a difference in cognitive deficits after aneurysmal subarachnoid haemorrhage and subarachnoid haemorrhage of unknown origin?

In a retrospective follow-up study 38 patients with aneurysmal subarachnoid haemorrhage (SAH) and 20 patients without an angiographically proven source of SAH were tested neuropsychologically one to five years after the acute event. All patients were operated on early within 72 hours if an aneurysm was proven angiographically and all were treated with nimodipine. Both patient groups had comparable cognitive deficits in spite of the less severe SAH of non-aneurysmal origin. Only in two cognitive functions the groups differed significantly. The patients after non-aneurysmal SAH had a significantly lower mean in the IQ subtest similarities finding (p < 0.05), while the patients after aneurysmal SAH had a significantly lower mean in a test of visual cognition (p < 0.05). A more detailed analysis with clinically homogeneous subgroups was additionally performed. The results showed in the subgroup with poor clinical grades that patients with aneurysmal SAH were significantly more disturbed in focal cognitive functions like short- and long-term memory and word-finding capacity, while patients with SAH of unknown origin scored significantly worse in a neuropsychological test related to attention, which can be regarded as a more diffuse cognitive function.

Adolescent↗
PubMed1994

Lysis of basal ganglia haematoma with recombinant tissue plasminogen activator (rtPA) after stereotactic aspiration: initial results.

In a series of 10 patients with stereotactically treated basal ganglia haematoma rtPA was used to dissolve remaining clots. Pre-operative haematoma volume ranged between 39 and 111 cm3 (average 56 cm3). Stereotactic aspiration alone yielded an average volume reduction of 60% (range 23 to 78%). Haematoma cavity was instillated with rtPA repeatedly beginning 24 hours after the stereotactic intervention. At the end of rtPA therapy between 2 and 4 days after onset of the haemorrhage 67 to 92% (average 84%) of the initial haematoma was removed in all patients. More than 80% of the pre-operative clot could be removed in 8 out of 10 patients between day 2 and 4. There were no signs of rtPA related toxicity. At the end of the follow-up period (between 4 and 17 months--mean 8 months) 6 patients were awake, oriented and with a residual hemiparesis able to live in their familiar environment. It is concluded that local rtPA instillation is an effective additional treatment to further resolution of deep seated intracerebral haematomas after stereotactic aspiration.

Adult↗
PubMed1994

Pterional/Lateral approach to orbital tumors.

The purpose of this article is to detail our experience with an approach to primary pathologic conditions involving the orbit. In 27 patients these included tumors of the lacrimal gland, lymphangiomas, neurinomas, meningiomas, and various cysts of the orbit. Access to these lesions was gained by a lateral pterional approach with osteoclastic or osteoplastic removal of the lateral bony wall/roof of the orbit, and by entering adnexal contents following elevation of the lateral rectus muscle. This approach allowed for complete tumor removal in all patients. The specifics of this approach will be discussed and associated orbital complications will be detailed.

Journal Article↗
PubMed1994

Results of early aneurysm surgery in poor-grade patients.

A series of 76 poor-grade (Hunt and Hess IV and V) patients after aneurysmal subarachnoid haemorrhage and early operation, was investigated in terms of post-operative outcome. The overall outcome was favourable in 41 (54%) patients and unfavourable in 35 (46%) patients. The mortality rate of 28% in all poor-grade patients after early surgery was acceptable, compared to mortality rates ranging from approximately 95% to 100% in regimes with nonsurgical treatment.

Adult↗
PubMed1994

Preoperative localization of the central sulcus by dipole source analysis of early somatosensory evoked potentials and three-dimensional magnetic resonance imaging.

Surgery of lesions within or close to the central area of the brain always carries the risk of iatrogenic motor or sensory deficits. Functional localization by means of intraoperative direct stimulation of the motor area or by recording somatosensory evoked potentials (SSEP's) from the surface of the somatosensory cortex is believed to reduce the operative risk. The authors introduce the combination of dipole source analysis of scalp-recorded SSEP's with three-dimensional (3-D) magnetic resonance (MR) imaging as a tool for preoperative localization of the central sulcus. This provides information on both functional and structural localization for preoperative planning. Four repeated measurements of right and left median nerve SSEP's were obtained from 20 subjects. Dipole source analysis showed a retest reliability of the 3-D localization error of 2.9 +/- 2.0 mm. Compared to the MR evaluation, dipole source analysis was found to mark the central sulcus within 3 mm for 15 conditions (subjects x side of stimulation), while the 3-D MR measurement was accurate to within 6 mm for 10 conditions and 9 mm for 14 conditions. Dipole locations were confirmed in six patients who underwent surgery of the central region. With respect to this application, dipole source analysis combined with 3-D MR imaging appears to be a valuable tool for preoperative functional localization. The accuracy in localization will be further improved when realistic head models become available that can take into account individual head geometry. Further development of the proposed new method holds promise that evoked potentials and electroencephalography will gain greater use in presurgical functional localization.

Brain Diseases↗
PubMed1994

Primary eosinophilic granuloma of the oculomotor nerve. Case report.

The authors report the occurrence of primary eosinophilic granuloma of the oculomotor nerve without osseous involvement in a 68-year-old man. Histopathological and neuroradiological findings are discussed. This case demonstrates that eosinophilic granuloma should be included in the differential diagnosis of tumor in which cranial nerves are involved.

Aged↗
PubMed1993

Effect of recombinant tissue plasminogen activator on clot lysis and ventricular dilatation in the treatment of severe intraventricular haemorrhage.

Twelve patients with severe intraventricular haemorrhage (IVH) underwent intraventricular thrombolysis with recombinant tissue plasminogen activator (rtPA). External ventricular drainage was performed in all patients within 24 hours of haemorrhage. Fibrinolytic therapy was started within 24 hours from the onset of symptoms in ten cases, and in two further cases after 48 hours and 5 days, respectively. Two to 5 mg of rtPA were injected via the ventricular catheter into one or both lateral ventricles. The injection was repeated at intervals ranging from 6 to 24 hours until CT scans demonstrated a substantial reduction of intraventricular blood. The total rtPA doses per patient ranged from 3 to 31 mg. CT scans showed a marked reduction of intraventricular blood and normalization of ventricular size within 24 to 48 hours from the beginning of the fibrinolytic therapy. Rapid reduction of elevated intracranial pressure by continuous diversion of cerebrospinal fluid could be achieved in all patients, because the ventricular catheters never became obstructed by clotted blood during the fibrinolytic therapy. During the period of treatment, the level of consciousness, as classified according to the Glasgow Coma Scale, improved from a mean value of 7 to 12. One fatal case of meningitis most probably due to the ventriculostomy was the only complication related to the treatment. This method of treatment might improve the prognosis in patients in whom a large intraventricular haematoma volume, ventricular dilatation, and impaired cerebrospinal fluid circulation are major determinants for the outcome.

Aged↗
PubMed1993

Which neuropsychological deficits are hidden behind a good outcome (Glasgow = I) after aneurysmal subarachnoid hemorrhage?

A series of 31 patients with good neurological 6-month outcomes (Glasgow Outcome Scale = I) was examined with a battery of cognitive tests 1 to 5 years after aneurysmal subarachnoid hemorrhage (SAH) and early operation. The results showed a marked disability in 28 to 62% of these patients in the subtests of a complex choice reaction task. Short-term memory was impaired in 53% of the patients neuropsychologically examined, whereas 21% of them had a reduced long-term memory. Concentration was impaired in 7 to 16% of the SAH patients. Also, 10% of the patients rated Glasgow Outcome Scale = I had an indication for an aphasic language disturbance. Multivariate analysis proved significant harmful effects of the severity of the bleeding seen on computed tomographic scan (Fisher scale) on information processing and word-finding capacity. Patients who were older at the time of the SAH were significantly more disturbed in concentration, short-term memory, and information-processing capacity at follow-up. It can be concluded from these results that a good neurological outcome (Glasgow Outcome Scale = I) does not exclude persisting neuropsychological deficits. Therefore, the value of the clinical use of the Glasgow Outcome Scale is limited. As a consequence, a differentiated neuropsychological examination is proposed to evaluate the exact outcome of SAH patients.

Adult↗