Biomedical subjects
Publications and source records attributed to K Twerdy.
CT-guided stereolithography provides an acrylic model which exactly replicates the original structure. It allows optimal preoperative planning and intraoperative management. This application proved advantageous in surgical correction of a wide midline craniofacial cleft in a baby.
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Out of a series of 252 patients who underwent aneurysm surgery, 19 (7.5%) were operated on in a "peracute stage" in the poor grades Hunt & Hess IV (n = 11), IV-V (n = 2), and V (n = 6). All patients suffered from large aneurysmal intracerebral hematomas which were evacuated after decompressive craniotomies, all aneurysms (ACA: n = 1, ACoA: n = 4, MCA: n = 12, ICA: n = 2) could be clipped. 4 patients died within the first 3 postoperative days, 6 patients reached a poor result remaining in an apallic syndrome or a state of high invalidity, 8 obtained a fair result with personal autonomity, and 1 patient recovered completely. Although this kind of aneurysm bleeding is combined with high mortality and morbidity, we nevertheless emphasize its surgical treatment as soon as possible because of the lack of other efficient therapeutical procedures.
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A family with a history of cavernous angiomas of the brain was investigated by MRI. The disease was present in four generations of the family and is consistent with autosomal dominant inheritance. Among affected individuals, there was considerable variability in the extent of intraparenchymal cavernomas and neurological symptoms as a result of bleeding events. Three siblings manifested with seizures, two affected persons were symptom free at the time of investigation, and one sibling had neurological symptoms without certain correlation with cavernomas. The disease appeared to have an earlier onset in younger generations.
The uncommon complication of bilateral blindness resulting from a decompressive neurosurgical procedure is presented by the case of a 51-year old patient suffering from a traumatic chronic subdural haematoma. A breakdown of the altered vasoregulation of the optic nerves due to papilledema at the time of intracranial pressure drop is supposed to be the etiological background of optic atrophy and consequent amaurosis. The causal relationship of accident trauma and blindness in the presented case is pointed out.
Intrinsic brainstem gliomas carry the worst prognosis of all pediatric CNS tumors; only 10-25% of patients are expected to survive for more than two years. Over a period of four years seven intrinsic brainstem gliomas were diagnosed in children in one institution. Four of them underwent a rapidly fatal course, whilst one was diagnosed only two years ago, which is too recent for long-term evaluation. We report the case histories of the remaining two boys, who showed a favorable course of their disease. Presenting symptoms were headaches and signs of brainstem dysfunction with multiple bilateral cranial nerve palsies, ataxia and pyramidal tract signs. Diagnosis rested on neuroimaging (CAT scans and/or MRI scans). Both tumors were intrinsic brainstem gliomas, one diffuse and the other focal. They responded to treatment (radiotherapy and chemotherapy in the former patient and radiotherapy alone in the latter patient). The two boys became long-term survivors and have remained well, without evidence of disease, for more than 71 and 61 months, respectively, after completion of treatment. They are probably cured. Prompt therapy with curative intention is recommended, with consistent adherence to the chosen antitumor regimen even in poor-risk brainstem gliomas.
The historical development of neurosurgery at the University of Innsbruck is presented, starting in 1906 with the proposed transethmoidal approach to the pituitary by H. Schloffer. The unit was founded by B. Breitner and W. Sorgo in 1947. In 1951 K. Kloss took over the unit, which grew into a university department and he became the first Professor of Neurosurgery in Innsbruck in 1972. From then on diagnostic and surgical procedures, as well as scientific research progressed rapidly. V. Grunert followed the deceased K. Kloss in 1980. Currently over 1500 major surgical procedures are performed annually according to the most modern standards.
This study is based on 147 depressed fractures of the calvaria. 60% of the diagnosed and treated cases were compound depressed fractures. Of the 147 patients 12 developed intracerebral, epidural and subdural hematomas. 3 persons developed infections. Of course the decision to institute prophylactic anticonvulsive therapy we only found 7 cases of posttraumatic epilepsy. Because of our experience in treatment of the depressed fracture we divide a consequent and rapid diagnosis by X-rays in combination with modern computer-tomography.
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Subdural empyema is a rare, but severe complication after skull-brain trauma and/or sinusitis. On the basis of four of our own cases the symptomatology, diagnostic problems and therapeutical management are discussed. Therapy should be an enlarged burr-hole trepanation or--if thick membranes develop--craniotomy and drainage of the empyema cavity. The use of modern CNS-penetrating antibiotics has canaed previously high mortality to decrease impressively.
A patient with a giant aneurysm of the inferior wall of internal carotid artery presented with progressive vision failure with optic nerve atrophy on the left eye. She underwent exploration of the aneurysm, which was found impossible to clip. Clamping of the common carotid artery was not tolerated there being inadequate collateral circulation. A saphenous vein graft was interposed between the occipital artery and a branch of the middle cerebral artery. The previously unruptured aneurysm bled fatally 4 hours after surgery, just before intended clipping of the aneurysm or ligation of the internal carotid artery.
Of 3,946 patients with lumbar disc herniation, who were operated on from 1980 to 1987 at the Clinic of Neurosurgery of the University of Innsbruck, 11 consecutive patients (0.27%) were younger than 19 years. In 9 patients (82%) there was radicular pain; in 90% the straight-leg raising test was positive, in 36% there was clear relation trauma to the onset of symptoms. Water-soluble contrast myelography or computerized tomography were used to confirm the diagnosis, in 36% both investigations. In 91% the surgical procedure was unilateral partial hemilaminectomy and in one case a laminectomy. In all cases a good or excellent result could be achieved.
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Between 1981 and 1985 at our clinic 204 consecutive patients underwent surgical repair of cerebral aneurysms after spontaneous subarachnoid hemorrhage. Of these 113 were treated with Nimodipine, a predominantly cerebrovaskular-active substance. The preoperative condition according to Hunt and Hess (9), the locations of the aneurysms, and the ages of the two groups of patients were directly comparable. The incidence of postoperative cerebral vasospasm was however higher in the Nimodipine group (49%) than in the control group (33%). Retrospectively we analyzed the progress of the patients as to their neurological, intellectual, and social function for up to five years after the operation. Mortality and morbidity in the Nimodipine group amounted to 10% and 7% respectively, in the group without Nimodipine 20% and 17% respectively (p less than 0.001). Of the Nimodipine patients, 72% showed excellent neurological outcome, with 73% intellectually, and 72% completely resocialized, as compared to 53% in the control group with an excellent neurological outcome, 39% intellectually intact (p less than 0.0001, and 52% completely resocialized (p less than 0.01). These results suggest that Nimodipine not only increases cerebral blood flow, but also protects brain tissue from ischemic damage.
On hand of 43 patients who underwent surgical closure of the rhino-frontobasis because of lesions in this localization (38 frontobasal fractures, 2 encephaloceles, 3 defects after surgery of olfactorius-meningeomas) our experiences as well as indications and techniques of the transcranial-subfrontal approach are reported. As there was quite a high number of patients in this group (n = 23, 53%) who - retrospectively - suffered of at least one severe meningitis, the authors stress their opinion that the indication for surgical procedure should be affirmed as consistently as possible, especially in cases were primary rhino-liquorrheas have stopped and bony defects have not been verified in predelective localizations.