Biomedical subjects

M H Reinges

Publications and source records attributed to M H Reinges.

28 records · Page 2Linked to original sources

PubMed2000

Frameless stereotactically guided catheter placement and fibrinolytic therapy for spontaneous intracerebral hematomas: technical aspects and initial clinical results.

OBJECTIVE: Frame-based stereotactic puncture and catheter placement followed by fibrinolytic therapy and drainage is one treatment option in the management of spontaneous intracerebral hemorrhage (sICH). This minimally invasive procedure could even be simplified by frameless stereotaxy. The authors present their experiences with frameless stereotactic image-guided catheter placement for lysis and drainage of sICH, with emphasis on technical aspects. METHOD: In 27 patients with sICH, an infrared-based frameless stereotactic device was used for selecting trajectory and target point of hematoma drainage. A trajectory along the main axis of the hematoma was considered to be optimal for fibrinolytic therapy. An articulated arm served to maintain the predetermined trajectory during surgery and to guide catheter advancement. Clot lysis with recombinant tissue plasminogen activator (rt-PA) was initiated after radiological confirmation of correct catheter positioning. RESULTS: In all cases, selection of the optimal trajectory was not restricted by the frameless stereotactic device. In 25 of the 27 patients, the catheter was placed accurately along the predetermined trajectory into the target point. In two patients, the catheter was positioned at the lateral margin of the hematoma, excluding fibrinolytic therapy in one case. In 24 of 27 patients, the mean hematoma volume could be reduced from initially 52 ml to 17 ml in an average of two days. Hematoma enlargement following rt-PA injection was observed in two patients. Further complications were culture negative pleocytosis of cerebrospinal fluid in two and meningitis in one patient. CONCLUSION: Hematoma puncture and catheter placement for fibrinolytic therapy could be achieved with high accuracy and safety using frameless stereotaxy. This method allows unrestricted trajectory selection with catheter positioning along the main hematoma axis. Further studies are required to investigate if frameless stereotactic puncture and clot lysis could contribute to improve the outcome of patients with sICH.

Adult↗

PubMed2000

Prospective analysis of bedside percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults.

OBJECTIVES: Although there is general agreement that surgery is the best treatment for chronic subdural haematoma (CSDH), the extent of the surgical intervention is not well defined. METHODS: The less invasive surgical technique of bedside percutaneous subdural tapping and spontaneous haematoma efflux after twist drill craniostomy under local anaesthesia was prospectively analysed in 118 adult patients, 99 with unilateral and 19 with bilateral CSDH. RESULTS: The mean number of subdural tappings was 3.2. Ninety two of the patients with unilateral CSDH were successfully treated by up to five subdural tappings, 95% of the patients with bilateral CSDH were successfully treated by up to 10 subdural tappings. The mean duration of inpatient treatment was 12 days. In 11 patients (9%) the treatment protocol had to be abandoned because of two acute subdural bleedings, two subdural empyemas, and seven cases of insufficient haematoma efflux and no neurological improvement. The only significant predictor for failure of the described treatment protocol was septation visible on preoperative CT. CONCLUSIONS: The described therapy protocol is-apart from a purely conservative treatment-the least invasive presently available surgical technique for treating chronic subdural haematoma. Its results are comparable with other modern treatment protocols. Thus, it can be recommended in all patients as a first and minimally invasive therapy, especially in patients in a poor general condition. Patients with septation visible on preoperative CT should be excluded from this form of treatment.

Adult↗

PubMed1999

Modification of a mechanical twist drill trephine for craniostomy in trauma patients.

A commercially available mechanical twist drill system was modified and evaluated in 35 craniotomies for frontal ventriculostomy in 31 trauma patients. The modified mechanical twist drill enabled faster and seemingly easier and safer craniotomy. It can be used as a safer alternative to common mechanical twist drill trephines, and is particularly recommended in difficult emergency conditions.

Adult↗

PubMed1998

Minimally invasive bedside craniotomy using a self-controlling pre-adjustable mechanical twist drill trephine.

BACKGROUND: Craniotomy with a mechanical twist drill is a standard, minimally invasive procedure in neurosurgery, widely used for the drainage of chronic subdural hematomas and the placement of ventricular drains. Nevertheless, the use of a standard twist drill trephine bears the risk of causing cerebral lesions. METHOD: A commercially available mechanical twist drill system has been modified by a special self-controlling drill and a pre-adjustable distance holder that limits intracerebral penetration. After initial cadaver testing, the modified trephine has been used for 65 trephinations in patients (37 chronic subdural hematomas, 21 external ventricular drains, 6 frontal hygromas, 1 tumor cyst). RESULTS: There were no complications related to the modified trephine; cerebral lesions caused by drilling too deeply or by uncontrolled penetration were safely prevented. In our series no procedure related infections occurred, and the drilling time was reduced significantly. CONCLUSION: The described modified mechanical twist drill enables fast, easy, and safe craniotomy without jeopardizing the advantages of a mechanical twist drill. Therefore, it can be recommended particularly for difficult emergency conditions.

Brain Injuries↗

PubMed1998

Experience with a new multifunctional articulated instrument holder in minimally invasive navigated neurosurgery.

A new multifunctional articulated instrument holder for use in minimally invasive navigated neurosurgery is presented. The instrument holder is secured to the Mayfield clamp, yielding permanent fixation and guidance of instruments. Thus, surgical conditions with the advantages of both conventional and frameless stereotaxic neurosurgery are created without sacrificing the relevant advantages of both methods. Accuracy testing of the instrument holder in combination with the neuronavigation system EasyGuide Neuro demonstrated an error of 0.0 to 2.4 (mean 1.6) mm. In clinical testing, the device has been used for guided catheter insertions, pointer fixation for continuous intraoperative guidance and trajectory planning, navigated endoscopic procedures, and navigated intracerebral biopsies in totally 53 patients.

Equipment Design↗

PubMed1998

The combined use of image-guided frameless stereotaxy and neuroendoscopy for the surgical management of occlusive hydrocephalus and intracranial cysts.

The objective of the study was to report the initial experiences with the combined use of an infrared-based frameless stereotactic navigation device and neuroendoscopy. Ten hydrocephalic patients underwent endoscopic third ventriculostomy and two patients with intracranial cysts underwent cystoventriculostomy. The trajectory of the rigid endoscope and target point were planned by frameless stereotaxy. An articulated arm served to maintain the predetermined trajectory during the surgery and to guide the endoscope. Endoscopic surgery was successfully performed in 11 of the 12 patients. In one patient with a small third ventricle the ventriculostomy had to be abandoned. We observed no surgical morbidity. In none of the cases was it necessary to correct the predetermined trajectory of the endoscope to reach the planned target area. The planning of the trajectory and the target area, as well as the maintenance of the trajectory during endoscopy reduce the risk of inadvertent damage to vital structures. The combined use of frameless stereotaxy and neuroendoscopy might contribute to a decrease of procedure-related morbidity.

Adolescent↗

PubMed1997

Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part II: Clinical experiences.

The surgical aim in the treatment of symptomatic lumbar spinal stenosis is the relief of the patient's complaints by an adequate neural decompression. Unilateral laminotomy and bilateral spinal canal decompression represents such a safe, effective and minimally invasive surgical method. This technique has been successfully used in the operative treatment of 29 patients with symptomatic mono- or multisegmental lumbar stenosis. There was no surgically induced neurological deterioration. In one patient, an inadvertent dural tear occurred, and due to unchanged symptoms another patient with a multisegmental stenosis had to be re-operated on at an additional level. Postoperatively, 25 of the 27 patients with neurogenic claudication (93%) demonstrated a marked improvement of the walking distance. The follow-up of 25 patients (mean follow-up time was 18 months) demonstrated an excellent result without pain in 7 patients (28%); a good outcome with mild residual pain, but a normal working capacity in 15 patients (60%); and a fair outcome with unchanged postoperative low-back pain but markedly improved working capacity and walking distance in 3 patients (12%). Postoperative morphometric evaluation as well as the clinical improvement of the patient's symptoms clearly demonstrated that bilateral ligamentectomy and recess decompression were adequately and successfully achieved via unilateral approach.

Adult↗

PubMed1994

Dynamic magnetic resonance imaging of the contralateral testis in patients with malignant tumor of the testis.

OBJECTIVES: Dynamic magnetic resonance imaging (MRI) was tested using a dynamic technique to evaluate the possibility of differentiating between normal contralateral testes and testes with a carcinoma in situ. METHODS: Since March 1990, 20 volunteers and 21 patients with a malignant tumor of the testis were examined in a field strength of 1.5 Tesla (Philips Gyroscan S15) with a multislice T1-weighted fast field echo sequence before and every 63 seconds after the injection of 0.1 mmol/kg gadolinium-diethylenetriamine pentaacetic acid. RESULTS: Significant differences (p < 0.001) in signal changes of contralateral testes were detected in dynamic MRI. This increased signal enhancement is detected even 45 months after orchiectomy in the contralateral testes. The signal increase is reduced in follow-up controls. These observations are explained by an increased perfusion which seems to be induced after a postoperative irritation, an unspecific inflammation, or postoperative bleeding. CONCLUSIONS: To avoid false-positive diagnoses of tumors or carcinomata in situ in contralateral testes, these increased enhancements caused by postoperative reactions have to be kept in mind.

Adult↗

PubMed1994

[Differentiation of testicular diseases using dynamic MRT].

Sonography and colour-coded Doppler sonography are the methods of first choice in diagnosing tumors of the testes. The present study aimed at resolving whether dynamic MRT can improve diagnostic relevance in diseases of the testes compared with conventional spin echo images. The testes of 20 healthy volunteers and of 16 patients of the Department of Urology of the University of Bonn were examined by means of MR tomography. Within 12 hours after MR tomography the patients were surgically explored, biopsied and if necessary orchiectomised. Results obtained with the volunteers were uniform and well reproducible, independent of external influences. On comparing the maximal enhancement curves of the examined various testicular tumors with the standard values established by examining the healthy volunteers, the curves obtained with the malignant testicular tumors were always clearly above the chosen confidence range of 3 standard deviations so that malignancy diagnosis was easy. However, the degree of maximal enhancement did not enable us to arrive at a conclusion in respect of the tumor type or the degree of malignancy. The greatest enhancement occurred with the tumor of Sertoli's cell which could thus be clearly differentiated against the other malignant testicular tumors. Due to masking of the gadolinium effect by haemosiderin deposits, haemorrhagica in the tumor tissue should be excluded by means of T2-weighted spin echo sequences before following up a suspicion of malignant testicular tumor. Benign intratesticular changes could be safely separated from malignant findings by means of the maximal enhancement curve lying in the normal range or below the curve of the volunteers. As with other organs, dynamic MR tomography yields definitely more and better information than conventional MR tomography also in the diagnosis of testicular tumours. However, these "pros" do not offset the "cons" of high costs of such examinations, so that both conventional sonography and angiodynography remain the routine methods of choice. Indication for MR examination on suspicion of testicular tumour is therefore confined to cases where sonographic findings are clinically equivocal or technically unsatisfactory.

Adult↗

PubMedDate not supplied

Surgically treated traumatic synchondrotic disruption of the odontoid process in a 15-month-old girl.

A case of traumatic synchondrotic disruption in a 15-month-old girl is reported; she was treated with interlaminar wiring of C1-C2 without grafting. Reduction of the dislocation and angulation and stability were achieved without evidence of growth disturbance. However, the child's initial poor neurological status with tetraplegia below the level of C7 remained unchanged. Besides our case, there are only three other cases in the literature of young children primarily operated on for a traumatic odontoid synchondrotic disruption. Even though the dorsal interlaminar wiring of C1-C2 without grafting is an easy and safe procedure even in the very young, the optimal form of treatment for this rare injury is still unsettled.

Bone Wires↗