The value of 3D magnetic resonance imaging in the planning of neurosurgery.
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Brain↗
Biomedical subjects
M Brock
Publications and source records attributed to M Brock.
Evoked potentials.
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Electric Stimulation↗
Contrast echocardiography and transcranial Doppler sonography for detection of a patent foramen ovale.
We report the case of a patient, in whom a patent foramen ovale was detected. For the detection of a patent foramen ovale simulation of Valsalva's manoeuvre with a positive airway pressure of 20 cm H2O was applied. Change of ventilation manoeuvre by ventilation with positive airway pressure of 35/30/15 cm H2O at a tidal volume of 1200 ml make a distinct increase in passage of contrast medium from the right to the left atrium. These findings were detected by contrast transesophageal echocardiography and indirectly by transcranial Doppler sonography and were reproducible. This may stress the importance of preoperative screening of patent foramen ovale in patients to be operated on in the sitting position. Contrast echocardiography and the ventilatory manoeuvre with high airway pressure and PEEP might increase the detection rate of patent foramen ovale with a right to left shunt during general anaesthesia.
Echocardiography↗
Lumbar spinal stenosis.
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Journal Article↗
The use of direct intra-operative Doppler ultrasonography in carotid thromboendarteriectomy. A prospective study.
Large multicenter studies have recently provided long-term results substantiating the superiority of surgical as compared to conservative treatment for symptomatic and asymptomatic extracranial internal carotid stenoses of more than 70%. These results led to an increase in the frequency of thrombo-endarteriectomies. However, indications are limited by the peri-operative complication rate. This explains the need for intra-operative quality control. The present study compares the standard method of intra-operative quality control in carotid surgery, i.e., intra-operative angiography (IOA), with direct intra-operative Doppler ultrasonography (IDU). Thirty-four patients who underwent carotid thrombo-endarteriectomy (carotid TEA) for a symptomatic (n = 15) or asymptomatic (n = 19) carotid stenosis of more than 70% were submitted to both intra-operative IOA and IDU. The sensitivity and specificity of the two techniques were compared in the light of the intra-operative findings. IDU seems to be superior to IOA in the detection of vasospasm. IOA has a higher sensitivity in demonstrating minisaccules, which, however, are not therapeutically relevant. The other findings obtained with both methods were considered to be of equal value. There were no false negative results by IDU regarding therapeutically relevant findings. We therefore consider it advisable to apply IDU in every case of carotid TEA. IOA should be performed in patients with vessel changes detected by IDU.
Aged↗
Neoplasm of endolymphatic sac origin: clinical, radiological and pathological features.
This paper reports on a 55-year-old female who had undergone middle ear surgery 12 years previously and was admitted with a 6-months history of unilateral hearing loss and facial weakness. MRI and CT demonstrated a space-occupying lesion arising from the temporal bone and extending into the posterior fossa. Treatment consisted in complete tumour removal. Temporal and mastoid bone destruction associated with typical histological features led to the diagnosis of neoplasm of endolymphatic sac origin. Clinical, histological, radiological and intra-operative features of these rare tumours are described and discussed. The pertinent literature is reviewed.
Cholesteatoma, Middle Ear↗
The value of intraoperative angiography for surgical treatment of cerebral arteriovenous malformations in eloquent brain areas.
Intraoperative digital subtraction angiography (DSA) allows intraoperative assessment of outcome of cerebral arteriovenous malformations (AVM). This study reports on 21 patients with AVMs in eloquent areas of the brain extirpated between July 1995 to March 1998. Extirpation was always followed by intraoperative DSA. Intraoperative angiography disclosed an occult residual nidus in 4 cases (19%). Complete extirpation of the AVM was achieved in all cases. Following surgery the neurological condition improved in 15 cases (71%), remained unchanged in 5 (24%), and worsened in 1. There were no secondary postoperative haemorrhages, nor complications related to the angiography. These results indicate that intraoperative DSA should be considered in the course of surgical treatment of cerebral AVMs in eloquent areas of the brain.
Adolescent↗
Adult neuronal ceroid lipofuscinosis with clinical findings consistent with a butterfly glioma. Case report.
The authors report a case of neuronal ceroid lipofuscinosis (Kufs' disease) confirmed by stereotactically obtained brain biopsy findings and initially diagnosed as a butterfly glioma. The presenting symptoms in the 64-year-old patient were mental alterations with progressive dementia, followed by muscular atrophy and myoclonia with distal preponderance. The mild initial disturbances of coordination increased, and the patient developed a markedly ataxic gait. Computerized tomography (CT) scanning and magnetic resonance imaging revealed generalized cerebral atrophy and a bifrontal space-occupying lesion involving the callosum. The original "clearcut" diagnosis of glioblastoma multiforme, based on CT scans, was unexpectedly disproved by examination of stereotactically obtained brain biopsy specimens, which revealed a neuronal ceroid lipofuscinosis (Kufs' disease). To the authors' knowledge, this is the first report of a case presenting with both diffuse brain atrophy and localized accumulation of neuronal lipofuscin, mimicking a mass lesion on radiological studies.
Atrophy↗
Pallidal or subthalamic stimulation.
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Electric Stimulation↗
Precise localisation of single-word retrieval in the left cerebral hemisphere.
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Brain Mapping↗
Leadership qualities in prominent neurosurgeons.
Our questionnaire provided a unique occasion to unravel the characteristics of leading neurosurgeons. As is also the case for successful leaders in other fields, neurosurgical leaders are good at school, used to being confronted with dilemmas, truthloving, ambitious, and, of course, gifted. They constitute a hardworking elite. The key to success is awareness. Awareness of oneself awareness of one's surroundings, awareness of the message to be delivered, awareness of the difficulties to be overcome and of their solutions. Awareness requires mental readiness, and this is directly linked to performance excellence in surgery [6].
Achievement↗
Magnetic resonance myelography (MRM) as a spinal examination technique.
PURPOSE: Conventional myelography involves side effects and complications due to puncture of CSF space and injection of contrast medium. On the other hand, MR-myelography (MRM) is a new noninvasive method requiring neither puncture nor contrast medium and causing no side effects. The diagnostic value and accuracy of MRM was evaluated in comparison with conventional myelography. MATERIALS AND METHODS: In this prospective comparative study, 41 patients (17 male, 24 female, mean age 42 years) with radicular symptoms underwent conventional lumbar myelography and were also submitted to MRM. Evaluation was performed in a blind manner by two independent examiners. RESULTS: The specificity and sensitivity of the methods are identical. MRM shows 35 cases of thecal indentation with amputation of a nerve root sheath and 6 cases of spinal stenosis. The results of conventional myelography and MRM were surgically confirmed in 38 patients. CONCLUSIONS: Both methods have the same diagnostic accuracy, but MRM requires neither puncture nor contrast medium nor x-rays.
Adult↗
Periradicular therapy in lumbar radicular syndromes: methodology and results.
Periradicular therapy (PRT) has become popular in the treatment of lumbar radicular complaints, both primary, due to disc herniations (Group 1), and postoperative, following disc surgery (Group 2). However, hitherto reported data on 'periradicular injections' are more of a technical nature. The present study was designed to evaluate the therapeutic success of CT- versus fluoroscope-guided periradicular injections of local anaesthetics and corticoids, and to investigate the impact of imaging procedures on the results. We report on 80 patients who underwent CT-guided (n = 40) or fluoroscope-guided (n = 40) PRT for lumbar radicular irritation since April 1993. Forty patients had primary nerve root irritation due to disc protrusion, and 40 suffered from postoperative epidural fibrosis. Follow-up consisted in a clinical examination and an interview one day after each injection as well as 1 and 6 months later. Assessment was based on a score taking into account the clinical findings, the patient's complaints, and the patient's evaluation. Six months following treatment there was a significant reduction of ischialgia in both Groups 1 and 2 (p < 0.001). However, the results were significantly poorer in Group 2 (postoperative). Among the patients not operated on, those who underwent CT-guided injections had a significantly better outcome (p < 0.001). PRT had no significant influence on low back pain or pseudoradicular syndromes. The improvement of sensory disturbances achieved by both CT- and fluoroscope-guided injections in patients not previously submitted to surgery is statistically significant (p < 0.05). As compared to Group 1 (no surgery), the positive effects in patients of Group 2 were of significantly shorter duration (p < 0.05). Motor deficits were not influenced by the treatment. Long-term follow-up shows that there is no positive effect in those patients in whom the first two PRT attempts had failed. Thus, PRT represents a useful long-term therapeutic alternative for lumbar radicular syndromes, particularly when due to primary discogenic compression. CT-guided injection is superior to fluoroscope-assisted treatment for both its visualization and its longer-lasting effect.
Adult↗
Permanent postoperative anosmia: a hitherto undescribed complication following surgery of the posterior cranial fossa in the sitting position.
Although the sitting position offers advantages for posterior fossa surgery, it is accompanied by complications such as air embolism and pneumatocephalus. Subdural and epidural haematomas are less common postoperative complications of posterior fossa surgery. To the best of our knowledge, however, anosmia is not a known sequela of surgery in the sitting position. It has been described following aneurysm surgery in the rostral part of the circle of Willis and is, of course, well known in traumatic brain injury.
Aged↗
The relationship between cortical injury and brain tumour. Report of two cases and review of the literature.
We report on two cases of brain tumour and discuss the possible relationship to previous cortical trauma. The first patient, a 67-year-old male patient developed a glioblastoma at the same site of an open shell-splinter injury of the brain after a latency of 48 years. The second patient, a 55-year-old male, had a malignant anaplastic astrocytoma in the right frontal lobe 10 years after clipping of an aneurysm of the anterior communicating artery. Both cases fulfill the criteria of Zülch [52] for the correlation between cortical trauma and tumour. We believe that the development of a brain tumour following a cortical injury is very rare, although possible. Probably the brain must display some form of predisposing genetic alteration for a tumour to develop following a cortical injury.
Aged↗
Guidelines for treatment of head injury in adults. Opinions of a group of neurosurgeons.
There are a number of parallel activities world wide to devise guidelines for the treatment of head injuries. A Group of neurosurgeons from various European countries worked on guidelines during three informal meetings, which may serve as a base for discussion of national or local protocols. Three levels of certainty were distinguished: Measures that must be taken which such a high degree of certainty, that they have not seriously been challenged-principles. Measures, that should be taken, as there is reasonable evidence in the literature about its efficacy-recommendations and measures that may be taken, but proof of its efficacy is lacking-optional measures. Protocols based on these guidelines are felt to help young neurosurgeons in training, define neurosurgical needs for other specialities and enhance the general efficacy of care for the head injured patient including multiple injuries.
Adult↗
[Indications for surgical therapy of aneurysmic subarachnoid hemorrhage--current status].
The most common cause of spontaneous subarachnoid bleeding (SAB) is a freshly ruptured cerebral aneurysm. The prognosis of an aneurysmal SAB essentially depends on the extent of the bleeding, the sequelae of subsequent vasospasms and the increase in intracranial pressure. Effective measures, such as increasing systemic blood pressure, can only be taken if the aneurysm is eliminated as quickly as possible. However, there are situations in which waiting is indicated. Clipping a cerebral aneurysm is a demanding operation, which requires a high degree of concentration and competence from the entire surgical team. A review of the literature (1990-1996) and a survey of 10 German and 10 international cerebrovascular centers yielded the following update of indications and contraindications for the surgical management of aneurysmal SAB: There is an absolute contraindication for aneurysm clipping in patients over 80 years of age in stage V according to Hunt and Hess and in poor general condition. There is a relative contraindication in patients over 90 years of age no matter what the stage according to Hunt and Hess is, as well as in those over 70 years in stage V according to Hunt and Hess and in poor general condition. Different opinions have been expressed for patients over 70 years in stage V according to Hunt and Hess. The surgical indication is controversial in patients with vasospasm detected by Doppler ultrasonography or by angiography. Emergency aneurysm clipping is performed in the presence of a space-occupying intracranial hematoma. Otherwise, emergency aneurysm elimination is not performed at night in any of the hospitals surveyed, but both angiography and surgery are carried out the next morning in the majority of hospitals. A tired neurosurgeon or surgical team operating at night may constitute a greater risk for the patient than rebleeding. For legal reasons, this aspect was discussed and accepted as another relative contraindication in the annual meeting of the German Neurosurgical Society in Hamburg in 1996.
Aged↗
Multiple arteriovenous malformations of the spinal cord in an adolescent: case report.
We report long-term follow-up of a rare multiple arteriovenous malformation of the spinal cord in a 15-year-old patient. A significant reduction in the size of the lesion was achieved by microsurgical resection of the dorsal and lateral portions. This eliminated the initial source of subarachnoid haemorrhage, and the patient's condition remained stable for 10 years. Renewed angiography of the residual ventrolateral malformation became necessary after recurrent subarachnoid haemorrhage, and the centre of the malformation was embolised selectively with bucrylate. Following embolisation, prophylactic treatment with steroids and heparin led to rapid improvement of the pre-embolisation symptoms. Our observations indicate that venous flow in the spinal cord is highly sensitive to haemodynamic changes. The angioarchitecture was indicative of multifocal arteriovenous shunts, an extremely rare condition, and the question arises whether these shunts were acquired or congenital.
Adolescent↗