Biomedical subjects

K Mursch

Publications and source records attributed to K Mursch.

29 records · Page 2Linked to original sources

PubMed1998

The value of transcranial duplex sonography in the management of patients subsequent to surgery for middle cerebral artery aneurysms.

OBJECTIVE: We intended to evaluate the value of transcranial color-coded duplex sonography (TCCS) in the management of patients after clipping of an aneurysm of the middle cerebral artery. Question was whether this method was able to predict poor clinical outcome by detection of local circulation disorders in the postoperative course. METHODS: A series of 15 consecutive patients was examined daily by TCCS. Special attention was paid to the branches of the middle cerebral artery distal from the clip (M2 branches). We correlated the TCCS results to the clinical outcome and occurrence of infarction on CCT. RESULTS: In six patients, one or more M2 branches could not be found in the immediate postoperative course, but reappeared after a period of 1-12 days in five patients. The three patients with a missing signal for more than 4 days suffered from infarction of the dependent territory and permanent neurological deficit not due to vasospasm of the middle cerebral artery. In the nine patients with constant TCCS signals, there was only one infarction due to pre-hospital systemical hypotension. CONCLUSION: TCCS cannot give exact postoperative information about incidental vessel occlusion during surgery for MCA aneurysms because M2 branches can remain invisible for some days without being occluded, but this invisibility seems to be coupled with ischemic complications.

Adult↗

PubMed1998

Visually evoked potentials in 52 children requiring operative repair of craniosynostosis.

We evaluated the prevalence of pathological visually evoked potentials (VEP) before the appearance of papilledema or other signs of elevated intracranial pressure in children suffering from craniosynostosis. In 52 children (19 girls, 33 boys, median age 7.6 months, mean age 7.6 months, range from 3 to 34 months) preoperative VEP were analyzed. In 13 patients, pathological VEP were observed. In all children, both eyes were involved. Only 1 child suffered from papillar anomalies. Latency was pathological in 12 children, whereas the amplitude was suppressed in only 2 children. In all children with preoperative pathological VEP, postoperative controls (n = 4) were improved or normal. Thus, VEP may be the first test for neuronal damage in craniosynostosis.

Child, Preschool↗

PubMed1997

[Trigeminal neuralgia as symptom of an infratentorial space-occupying process].

UNLABELLED: Despite excellent technical means of imaging the posterior fossa by magnetic resonance imaging (MRI), some infratentorial space-occupying processes still remain undiscovered, especially if they present only slight symptoms or imitate typical different diseases. METHODS: We analysed the data of 334 patients who were admitted because of infratentorial space-occupying processes in the years 1986 to 1995. RESULTS: There were six patients with trigeminal neuralgia caused by infratentorial tumors. In only one was the tumour previously diagnosed. All suffered from tic douloureux; two had undergone operative treatment. Mean latency from first symptoms until diagnosis was 48 months. On admission all patients presented at least slight neurological deficits. Postoperatively, the patients remained pain-free. CONCLUSION: Because the prognosis of operative treatment and the occurrence of postoperative deficits depend on tumour size, we advocate MRI examination in every patient presenting tic douloureux, even without additional neurological signs.

English Abstract↗

PubMed1997

Intra-axial endophytic tumors in the pons and/or medulla oblongata. II. Intraoperative findings, postoperative results, and 2-year follow up in 25 children.

Between July 1987 and June 1994 we operated upon 30 consecutive children suffering from endophytic intra-axial tumors located in the pons and/or medulla oblongata. The 25 children operated on between July 1987 and October 1993 whose postoperative course could be assessed for a minimum of 2 years after operation were included in this study. Operability of a brain stem tumor was shown to be independent of its size. A gross tumor resection between 80% and 100% could be performed in half these cases, and subtotal or partial resection in the other half. The radicality of resection was not influenced by tumor histopathology, but was dependent on intraoperative findings relating to its consistency, infiltration, and visibility. On follow up, 15 of the 25 children were found to have died within the period of 2 years. Two children died in the immediate postoperative period (at 2 days and 2 weeks after surgery), of acute brain stem swelling and an unsuspected bleeding disorder, respectively. The other 13 of these 15 children died of tumor progression between 1 and 19 months after operation, with a median survival time of 9 months. In the group of the surviving 10 children the histopathology was grade I astrocystoma in 6 cases, angioma in 2 cases, and grade II oligodendroglioma and grade II ependymoma in 1 case each. Postoperatively, most of the children showed some increase in their preoperative deficits, but recovered after 2-3 months. After 2 years, 10 of the 25 children who were followed up are alive and 9 of them attend regular school or kindergarten.

Adolescent↗

PubMed1997

Using transcranial duplex sonography for monitoring vessel patency during surgery for intracranial aneurysms.

This article reports a method for reliable intraoperative monitoring of blood flow velocities in the basal cerebral arteries during clipping of intracerebral aneurysms. Transcranial color-coded duplex sonography provides practical integration of transcranial Doppler technology with real-time imaging capabilities through the intact human skull. With a computerized sonography system equipped with a 2.5-MHz probe in 50 healthy volunteers, the contralateral internal carotid artery, A1 and A2, as well as M1 and P1 vessels were identified and measured in most patients. In 13 patients undergoing dipping of intracranial aneurysms, the technique successfully imaged 12; it allowed definitive identification of vessels potentially threatened by clipping and not fully visible to the surgeon. Data were easily comparable to preoperative data. This noninvasive, repeatable neuroimaging technique provides useful intraoperative information about intracranial hemodynamics during dipping of intracranial aneurysms.

Adult↗

PubMed1996

Intra-axial endophytic primitive neuroectodermal tumors in the pons: clinical, radiological, and immunohistochemical aspects in four children.

We present the clinical findings, radiological aspects, operative results, and histopathological features of four typical primitive neuroectodermal tumors (PNET) located in the pontine region in children. All the tumors had an endophytic intra-axial growth pattern. All the children had a short history of severe neurological deficits with involvement of the cranial nerves and pyramidal tract. MRI did not reveal any common feature of malignancy. Compared to our successful experience in operations of intra-axial endophytic brainstem tumors in a total of 32 children, the outcome was poor: all 4 children died within 13 months. We conclude that PNET occurring in the pons is not as rare as was believed, and, compared to PNET in other areas the prognosis is worse.

Actins↗

PubMed1996

Use of transcranial real-time ultrasonography for programming a shunt valve system.

For patients who suffer from hydrocephalus that is difficult to treat because of impaired intracranial compliance, a programmable shunt system may be a helpful alternative. However, especially during the first weeks after implantation, many radiological follow-up studies are necessary to achieve the optimum pressure level. The authors present the case of a 7-year-old boy who suffered from posthemorrhagic hydrocephalus and did not respond to conventional shunt valve systems. After implantation of a programmable shunt system, achieving the optimum craniospinal fluid (CSF) pressure level was difficult because the symptoms of over- and under-drainage were similar. Using transcranial real-time ultrasonography for evaluation of the diameter of the intracranial CSF spaces, we were able to adjust the correct pressure level without long-term intracranial pressure monitoring or daily computed tomography, which otherwise would have been necessary because of the ambiguous symptomatology. Transcranial real-time ultrasonography (TCUS) displays an image of the intracranial parenchyma and CSF spaces through the intact temporal bone and is a valuable, serially applicable bedside monitoring technique for patients requiring close imaging follow-up.

Cerebral Hemorrhage↗

PubMed1996

A stable positioning for patients requiring large calvarial exposure for surgical correction of cranial synostosis.

We present a simple and elegant method of positioning the child's head for repair of craniosynostosis. The Sugita head holder allows large exposure of the calvarium with little risk of injury, dislocation or extensive blood loss caused by venous compression. We operated upon 37 patients (age range, between 3 and 132 months, median age 7 months) and did not observe any complication or lesion caused by positioning.

Child↗

PubMed1995

Bedside measurement of the third ventricle's diameter during episodes of arising intracranial pressure after head trauma. Using transcranial real-time sonography for a non-invasive examination of intracranial compensation mechanisms.

Using transcranial real-time sonography, changes in the axial diameter of the third ventricle during manoeuvres, which increased intracranial pressure (ICP), were measured in 28 patients with moderate to severe head injury. The measurements were correlated with ICP measured by epidural pressure monitoring. We observed reductions in diameter ranging from 0.3 to 1.1 mm with rises in intracranial pressure of at least 5 mm in 22 patients of whom only one died. In 6 additional patients, no changes in diameter were seen, and 5 of the 6 died. We interpret that poor outcome as a measurable inability for the brain to expel cerebrospinal fluid into extracerebral compartments during increased ICP. Transcranial real-time sonography may provide additional information about intracranial cerebral fluid dynamics and compliance.

Adolescent↗

PubMed1995

[Transcranial color-coded real time ultrasound. An improvement in patient monitoring in the neurosurgical intensive care unit?].

It is still not always possible to detect in time early intracranial complications in neurosurgical critical care patients. In addition, the exact definition of the lesion requires an often life-threatening transport to the CCT. Hence, there is still a need for improved bedside monitoring. New developments in ultrasound technique enable us not only to get a two-dimensional image of intracranial parenchymatous structures through the intact bone but also to visualise, by means of colour-coding, the blood flow the intracranial vessels. In 70 mostly neurotraumatised patients we found that this method is helpful in solving diagnostic or therapeutic problems without the patient having to leave the intensive care unit.

Adolescent↗

PubMedDate not supplied

Localized proton NMR spectroscopy of brain tumors using short-echo time STEAM sequences.

Recent progress in localized proton NMR spectroscopy has been utilized to improve the spatial resolution and the metabolic specificity in a study of 19 patients with intracranial tumors. Selected examples demonstrate that short echo time stimulated echo acquisition mode sequences are able (a) to account for macroscopic tissue heterogeneity by reducing the volume of interest to 2-8 ml and (b) to facilitate a reasonable characterization of tumor metabolism by increasing the number of accessible metabolites. Proton NMR spectra were acquired within measuring times of 6.5 min on a 2.0 T whole-body system using the imaging headcoil.

Adult↗