Biomedical subjects
Publications and source records attributed to O Schubiger.
A case of surgically verified cerebral granulomatous angiitis, which was mistaken for a brain tumor on computed tomography, is reported. The focal, enhancing lesion was due to multiple confluent infarction caused by the angiitic process.
Subdural interhemispheric empyema was diagnosed by angiography and computerized tomography (CT) in a 7-year-old boy suffering from acute left hemiparesis. After neurosurgical intervention his condition improved. Peptostreptococcus intermedius was cultured from the empyema. One year after hospitalisation the boy is in good condition. The importance of the CT-scanning for diagnosis and management of brain abscess or empyema is stressed.
The minimal size of acoustic neuromas detectable by computered tomography (CT) is, according to the available literature, 1.5 to 2 cm. The new otoneurosurgical technic using the transtemporal and translabyrinthine approach necessitates an early diagnosis of neuromas protruding 1 cm or less into the cerebellopontine angle cistern. This seemed impossible with the available CT equipment. Eight proven acoustic neuromas 1 cm or less in diameter, detected with CT, are reported. Diagnostic criteria are elaborated. The study shows that small cerebellopontine angle tumors can be detected by use of CT machines of the newer generation which perform scanning with thin and overlapping slices.
With neurofibromatosis neuromas of the cranial and cervical nerves are common findings and meningiomas and ependymonas appear more often than in the average population. Vascular manifestations of the disease are also commonly known in the renal and gastrointestinal vessels but rarely in the large cerebral arteries. The case of a 50 year old man with neurofibromatosis and a vertebral aneurysm is reported. The plain X-ray of the cervical spine and the Pantopaque myelogram were compatible with a cervical neuroma and the patient was operated but a large aneurysm of the vertebral artery was found. The operation was discontinued and vertebral angiography was performed revealing a large saccular aneurysm which war excised. This aneurysm is most probably a manifestation of vascular disease with neurofibromatosis.
Obstructions in the extracranial cerebral arteries can be detected noninvasively by directional Doppler ultrasound technique using 'indirect' and 'direct' criteria. The indirect criteria are based on measurement of flow in the common carotid and in the terminal branches of the ophthalmic artery before and after the common carotid artery and branches of the external carotid artery are compressed. With the direct criteria, internal and external carotid artery are differentiated by diastolic flow, and local inhomogenetics of flow (turbulence) are detected. Flow in the vertebral artery is picked up transorally in the oropharynx. The Doppler examination was used in 2230 patients of whom 436 underwent angiography. The results of Doppler and angiography correlated in more than 90% of the cases.
The results of CT analysis of 41 acoustic neuromas are presented. Large and medium-sized tumors are easily detected: our results are comparable to the reported findings of other authors. The detectability of small acoustic neuromas is considerably improved by the application of newer-generation CT apparatus and the use of specific scanning parameters, including extremely thin overlapping slices, low scan speed, high gantry tilt, short time between contrast agent application and tumor scanning, and computer-assisted magnification of the posterior fossa.
Skull X-rays with special projections, particularly tomography of the temporal bone, are very helpful procedures in the differential diagnosis of diseases of the temporal bone. Tomography serves to delineate the size and distribution of tumors in the middle or inner ear. Furthermore, in fractures of the temporal bone the fracture line can be seen throughout the entire osseous structure. Special projections are reported for tomography of the temporal bone, with special emphasis on the indications for such procedures. Meatocisternography, a study in which the internal auditory canal is filled with contrast medium, shows defects caused by neurinomas. Indications for angiography (carotid or vertebral) are large neurinomas penetrating the posterior fossa or other tumors of the inner or middle ear, i.e. chemodectomas. A chemodectoma of the jugular bulb can also be demonstrated by jugular venography.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Twenty-six cases of surgically verified nonchromaffin paragangliomas (NCPs) of the temporal bone were investigated by contrast-enhanced, thin-section, multiplanar high-resolution computed tomography (CT). Based on the high-resolution CT findings the tumors were classified according to a recently introduced surgical classification of NCP into four main types (A, B, C1-C3, and D1-D3). With high-resolution CT tumors were correctly classified in all cases, as was shown with intraoperative correlation. On the basis of these findings, high-resolution CT should replace conventional tomography and should be regarded as complementary to selective angiography in the preoperative evaluation of NCP.
Explore the source record for details and available documents.
Seventy-seven patients with recurrent radicular symptoms after operation for lumbar disk herniation were examined by plain computed tomography (CT) and by intravenously enhanced CT. With the latter technique, scar tissue and recurrent disk herniation can be distinguished: scar tissue shows definite contrast enhancement whereas recurrent disk herniation remains unenhanced. Nerve roots surrounded by scar tissue are often visualized on the postcontrast scan as rounded lucencies. Symmetrical undisplaced nerve roots were identified in 88% of cases of hypertrophic scar formation; this finding excludes recurrent disk herniation. Dural calcifications were found in five patients with hypertrophic scar formation. The authors conclude that CT with contrast enhancement should be the method of choice for evaluating patients with recurrent radicular symptoms after operation for disk herniation.
A two-part anatomic and clinical high-resolution computed tomographic (HRCT) study of the fallopian canal was conducted. From the correlation of HRCT images of eight specimen temporal bones with their corresponding anatomic sectional images, it was evident that the full length of the fallopian canal can be accurately visualized. An axial section demonstrates the labyrinthine segment, geniculate ganglion fossa, and proximal part of the tympanic segment, whereas a Stenver projection is used for the tympanic segment, second knee, and mastoid segment. In clinical studies axial sections simultaneously visualized the proximal parts of the fallopian canal in 82% of 28 cases, whereas Stenver projections simultaneously visualized the distal parts in 75% of 16 cases of acute facial nerve palsy. Twenty-one patients with intratemporal facial nerve palsy and six patients with congenital atresia of the external auditory canal were also examined. HRCT was highly accurate in detecting and defining neoplastic, inflammatory, and congenital lesions of the fallopian canal. A lower rate of detection was recorded for traumatic lesions.
Between 1973 and 1978 spontaneous lysis of obstructions in an external cerebral artery was detected in seven out of 3500 patients who suffered from symptoms of cerebrovascular failure in the territory of the internal carotid or vertebral artery. All patients underwent our routine cerebrovascular Doppler ultrasound examination. In the seven patients a high grade obstruction in the internal carotid artery (six cases) or in the brachiocephalic trunk (one case) was found by Doppler and/or angiography 1-3 days after the onset of the symptoms. On a second examination 4-30 days later these obstructions were no longer present either in the Doppler examination and on the angiograms, or in the surgically exposed vessel. These findings suggest that spontaneous lysis of the obstructions must have occurred. Furthermore vascular surgery should not be delayed more than 3-7 days without another reliable vascular examination.