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Biomedical subjects

L Russegger

Publications and source records attributed to L Russegger.

At least 19 recordsLinked to original sources
PubMed1997

[Intrathecal administration of triamcinolone in treatment of pain after discectomy].

The efficacy and compatibility of intrathecal corticoid therapy was studied in a series of 160 patients (out of a total collective of 3000 patients operated on over a 5-year period for disc herniation) suffering from continuing pain in the first 5 days following discectomy. 80 patients received triamcinolone acetonide in crystalline suspension (Volon A 80, 2.0 ml) intrathecally via lumbar puncture on the 5th postoperative day (group A). The remaining 80 patients acted as controls (group B). Additionally, all patients were treated by conservative means. On the 6th, 8th and 12th postoperative day they all had to classify their wellbeing according to a 5-grade pain scale. On the 6th day 75% of group A patients assessed their symptoms as belonging to the favourable grades 1 and 2 (completely free of pain or slight remaining complaints), whereas only 5% of the control group did so (p < 0.0003). On the 8th and 12th postoperative day this difference was not as significant. All patients were examined again 4 weeks after discharge from the hospital. At this time the difference between the two groups was not statistically significant (p < 0.12). No general systemic effects due to intrathecal corticoid administration were recorded. However, in 11 cases (13%) postpunctional signs of greater or lesser severity, reaching from slight to severe headache with nausea and vomiting occurred. All these symptoms disappeared at the latest within 1 week and would--in our opinion--be avoidable by correct lumbar puncture technique. In general, this study revealed that intrathecal triamcinolone administration is highly effective in the relief of postdiscectomy pain and may reduce the period of postoperative pain significantly.

Adolescent↗
PubMed1997

First experiences with a distractible titanium implant in ventral cervical disc surgery: report on 30 consecutive cases.

A new titanium implant for ventral cervical fusion after microsurgical discectomy via a conventional antero-lateral approach is presented. The implant consists of a ventral fixation plate and a distractible disc space graft whose extension can be changed by adjusting a set screw. Additional fixation is achieved by four monocortical spongiosa screws. Thirty patients (14 men, mean age 46.5 years; 16 women, mean age 46.8 years), in whom the implant was used, were the subjects of this investigation. Twenty-eight patients suffered from monosegmental cervical disc herniations (C4/5: n = 3; C5/6: n = 14; C6/7: n = 12; C7/T1: n = 1) and two patients showed traumatic discoligamental instability (C5/6: n = 1, C6/7: n = 1). The postoperative follow-up was at least 12 months (range 12-26 months, average 16.6 months). All patients underwent a clinical control including functional X-rays 6-8 weeks and again 10-14 months after surgery. All had benefitted from the procedure and the clinical results were comparable to other ventral cervical fusion techniques. We observed neither overdistraction or dislocation of the implant nor loosening or breaking of the screws. The advantages of the implant are: simple handling, controlled distraction of the intervertebral space and avoidance of a "second operation" to obtain an iliac crest bone graft for fusion.

Adult↗
PubMed1996

[Sacral intradural arachnoid cysts as the cause of lumbar syndrome].

In two female individuals (37 and 47 years old) sacral intradural arachnoid cysts caused low back pain and sciatica for several years until the correct diagnosis was established by MR imaging. Both patients had micturition disturbances (pollakisuria). In both cases a sacral laminectomy was carried out and the dorsal border of the cyst wall was resected (marsupialisation) after evacuation of xanthochrome fluid. Neither cysts showed any communication with the subarachnoid space. Postoperatively the patients were free of complaints; pollakisuria disappeared within 2-4 weeks.

Adult↗
PubMed1993

Peracute surgery of aneurysms with intracerebral hematomas.

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.

Adult↗
PubMed1993

Spontaneous collapse of posttraumatic syringomyelia: serial magnetic resonance imaging.

The case of a 30-year-old man with posttraumatic syringomyelia involving the cervical and upper thoracic spine is reported. The patient was followed clinically and with magnetic resonance (MR) imaging over a 3-year period. Spontaneous complete remission of the syrinx-related symptoms correlated with a partial collapse of the syrinx, as proved by serial MR imaging.

Accidents, Traffic↗
PubMed1993

[Prognosis of epidural hematoma: is emergency burr hole trepanation in craniocerebral trauma still justified today?].

We made a retrospective study of the records of 80 patients with epidural haematoma, to investigate whether delay between injury and surgery and neurological status upon admission affect outcome after 3-6 months. Outcome was classified on a four-grade scale, grade 1 meaning full recovery and grade 4, death. Overall mortality was 13%. Patients operated on within 7 h after injury made a full recovery in 52%, and mortality in this group was 6%. Patients operated on between 7 h and 14 h after injury made a full recovery in 20%; mortality was 16%. Among the patients who were not comatose on admission a good outcome was achieved in 55% and mortality was 3%. The outcome in patients who were comatose on admission was rated grade 1 in 15% and grade 4 in 25%. The proportion of comatose patients and the mortality were higher in patients transferred from general hospitals. Textbook signs of epidural haematoma are not reliable aids to diagnosis and localization; for example a lucid interval occurred in only 58% of our patients. It is concluded that emergency burr hole trepanation might improve the outcome in patients showing signs of brain stem dysfunction after head injury, but prior computed tomography is necessary to guide such an intervention at the district hospital level.

Adolescent↗
PubMed1992

Increase in cerebrospinal fluid pressure in normocapnic volunteers in response to nalbuphine.

We have carried out a double-blind randomized study of the effect of nalbuphine (0.2 mg.kg-1 i.v.) or placebo on mean lumbar cerebrospinal fluid (CSF) pressure, mean cerebral perfusion pressure (CPP), transcutaneous PCO2 (tcPCO2), mean arterial blood pressure (MAP), and heart rate (HR) in 10 spontaneously breathing volunteers using invasive CSF pressure measurement. Nalbuphine increased CSF pressure from 9.2 mmHg to 16.4 mmHg and decreased CPP from 83.6 mmHg to 74.4 mmHg without significantly changing tcPCO2, MAP, or heart rate. In the placebo group there were no significant changes in CSF pressure, CPP, tcPCO2, MAP, or heart rate. These findings suggest that nalbuphine should be used with caution in patients at risk of intracranial hypertension.

Blood Gas Monitoring, Transcutaneous↗
PubMed1992

Electrophysiological findings in a case of severe intrathecal baclofen overdose.

Multimodality evoked potentials were examined in a case of serious accidental intrathecal baclofen overdose in a patient who suffered from severe spasticity due to a traumatic brain lesion. Electrophysiological findings during, before and after the intoxication were compared. Transcranial electrical stimulation up to 750 V did not evoke any responses in thenar muscles on the first day of intoxication. An improvement to normal values was observed within 3 days, paralleled by an amelioration of the patient's clinical condition. Cervical electrical stimulation was largely unaffected by baclofen. Median nerve somatosensory and brain-stem acoustic evoked potentials revealed few or no differences during intoxication compared to pre- and post-intoxication responses.

Adolescent↗
PubMed1992

[Chronic subdural hematoma as a cause for blindness].

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.

Blindness↗
PubMed1992

[Surgical treatment of glossopharyngeal neuralgia].

Glossopharyngeal neuralgia is a rare disease which is characterized by severe paroxysmal pain attacks in the distribution of the 9th cerebral nerve. Although uncommon, the condition has to be considered in the differential diagnosis of various craniofacial neuralgias. The purpose of this study was to describe 3 cases of glossopharyngeal neuralgias and to discuss its diagnosis and therapy. Various surgical therapeutic procedures have been described, including neurotomy of the glossopharyngeal nerve in the frontal neck, thermocoagulation of Andersch's ganglion, and para-pontine neurotomy (Dandy). Because of its good results and low incidence of recurrences, microvascular decompression (Jannetta) is considered the procedure of choice.

Adult↗
PubMed1992

Fentanyl increases cerebrospinal fluid pressure in normocapnic volunteers.

In a double blind randomized study, the effect of fentanyl 1 microgram kg-1 i.v. or placebo on mean lumbar cerebrospinal fluid pressure (CSFP), mean arterial pressure, cerebral perfusion pressure, transcutaneous PCO2 and heart rate was studied in 10 spontaneously breathing volunteers in the lateral decubitus position via a 22-gauge spinal needle inserted into the subarachnoidal space at level L3/L4. Fentanyl increased mean CSFP (+/- SD) from 12.4 +/- 2.7 mmHg to 16.0 +/- 2.3 mmHg (P < 0.05) without significant changes in the other variables. No significant changes in any of the measured variables were seen after administration of placebo. Cerebral perfusion pressure decreased significantly after fentanyl (P < 0.05).

Adult↗
PubMed1992

Indication, efficiency and complications of intrathecal pump supported baclofen treatment in spinal spasticity.

In 19 patients, who suffered from severe spinal spasticity of different etiologies and did not respond sufficiently to oral antispastic therapy, intrathecal Baclofen test boli were administered. In 11 patients a DAD (Drug Administration Device) [SynchroMedR Model 8611 H, Medtronic Inc. Minneapolis, USA] was implanted. Catheter dislocation or torsion was the most common complication to be observed in these 11 patients. Long term intrathecal Baclofen application was effective in all patients, as reducing spasticity, flexor spasms and spasm induced pain. In some cases the motor performance ameliorated.

Adult↗
PubMed1992

Long-term intrathecal baclofen treatment in supraspinal spasticity.

Baclofen, a derivate of gamma-amino butyric acid (GABA), is known to be a useful drug in spasticity treatment. To achieve a good therapeutic response higher oral dosages have to be administered related with central side effects. Intrathecal application of Baclofen in microgram range dosages is proved to be effective in spinal spasticity. The efficiency of intrathecal Baclofen in patients suffering from supraspinal spasticity is discussed controversially. We report on 9 patients with long-term intrathecal Baclofen treatment, all of them responding well presenting a marked reduced muscle tone. In most cases an improvement of motor performance and in two cases improved bladder function was observed. The therapeutical dosages administered to patients with supraspinal spasticity exceed those administered to patients with spinal spasticity by approximately 100% without provoking central side effects. Despite the risks connected with this method it has to be considered as treatment of choice in cases of severe supraspinal spasticity.

Adult↗
PubMed1991

[Experiences with Kahn's method of dentatotomy].

Between 1980 and 1990, 37 patients with cervical spondylotic myelopathy and syringomyelia underwent posterior decompression by laminectomy and dentatotomy. The preoperative symptoms are compared with the postoperative status. Spasticity and pyramidal signs were reduced. In our opinion, Kahn's indication for dentatotomy as described in 1946 is obsolete today. However, we believe that after extensive decompressive laminectomy an additional mobilising effect is recommendable, so that Kahn's operation is still of relevance as an additional procedure in the treatment of this condition.

Cervical Vertebrae↗
PubMed1991

[Surgical treatment of cervical intervertebral disk displacement].

Between the years 1976 und 1989 147 patients were operated on cervical disc herniation at the Neurosurgical Clinic of Innsbruck. 122 of these cases underwent a posterior approach according to Frykholm, 25 patients were treated by an anterior approach according to Cloward and Smith and Robinson, respectively. All patients received a descending myelography followed by a CAT-Scan of the questionable cervical segments the latter was available. In patients with disc herniation and only mild degenerative changes of the cervical spine a dorsal foraminotomy was chosen whereas the cases with nerve root compressions primarily due to spondylosis the ventral approach was preferred. Patients revealed a convincing benefit of motoric deficits after foraminotomy whereas disturbances of sensibility showed minor improvement either by ventral or posterior approach.

Adult↗
PubMed1990

[Tractotomy and partial nucleotomy as a form of therapy in refractory pain of the trigeminal nerve and cancer pain in the head and neck area].

Persistent trigeminal neuralgia, herpes zoster neuralgia of the first division of the trigeminal nerve and pain caused by cancer situated in the head and neck pose frustrating problems for patients and physicians. Tractotomy and/or partial vertical nucleotomy of the subnucleus caudalis nervi trigemini offers a logical approach to the treatment of such pain, since these structures contain fibres of the Vth nerve, as well as the somatosensory fibres of the VIIth, IXth and Xth nerve. Tactile and some thermal sensitivity of the face is preserved and anaesthesia dolorosa and keratitis neuroparalytica is avoided. Over the past 30 years 370 patients with therapy-refractory trigeminal pain, pain due to cancer of the head and neck and herpes zoster trigeminal pain were treated by means of tractotomy (personal series of V. Grunert), including 30 patients who underwent partial vertical nucleotomy. The mean age of the patients was 68 years (range 54-84 years). The mortality in this series was 0.9% (4 patients; one operative mortality due to air embolism, one postoperative cardiac failure following myocardial infarction and two intracerebral haematomas). 60% of the patients with persistent trigeminal neuralgia were pain-free and 28% improved, whereas 12% were unchanged or suffered from recurrent pain. Of the patients with cancer who complained of pain derived from the Vth, VIIth, IXth and Xth nerve, 40% demonstrated marked pain relief and 60% showed no improvement. Tractotomy and partial vertical nucleotomy offer a valuable method in experienced hands for relieving pain where other methods have failed.

Aged↗