Search PubMed⌕ Search

Biomedical subjects

P Oldenkott

Publications and source records attributed to P Oldenkott.

At least 19 recordsLinked to original sources
PubMed1994

Stereotactic and ultrasound guided minimal invasive surgery of subcortical cavernomas.

The experience of 7 operated patients with cavernous haemangiomas (CHa) and of 2 conservatively treated older patients is reported. There was no further postoperative neurological deficit, although 6 of the 7 patients had the CHa in an eloquent cerebral region. Two of the operated patients (22%) had several bleedings before surgery. In these cases seizures and visual field deficits remained. The relatively low rate of complications in our patient group was possible because an exact preoperative localisation helped to avoid a large traumatisation. This is possible with a stereotactic system or directly by CT guided skin marking. Intraoperative ultrasound was necessary in all cases because there was no landmark at the cerebral surface. The CHa was removed by a transsulcal microsurgical operation. A complete removal of the surrounding haemosiderin rim around the angioma seems necessary to avoid further seizures. The used technique has proved to be a simple and safe minimal invasive method.

Adolescent↗
PubMed1994

Endoscopic fenestration of the 3rd ventricular floor in aqueductal stenosis.

Six endoscopic fenestrations of the 3rd ventricular floor have been performed in patients with stenosis (SAS) of the aqueduct of Sylvius in our institute during the last two years. The endoscopic intraventricular landmarks were the Monro's foramen followed by the mamillary bodies. The fenestration instrument was a monopolar coagulation wire, the dilatation instrument was a balloon catheter. The patients included two newborns and four adults. The two newborns developed a recurrent hydrocephalus after 2 months. The four adults remained well after the operation. The only complication was edema (SIADH syndrome) in one case for 24 hours. Flow sensitised phase MRI showed a mirroring in the prestenotic CSF pulsation curve preoperatively. This, in combination with an increased intraventricular pulsation, is a sign of reduced capacity of the subarachnoid space at the cerebral surface. The postoperative patency of the fenestration with diminished intraventricular pulsation can be demonstrated with ECG retrogated phase MRI. There was a slow and incomplete decrease of the preoperative enlarged ventricular size. This operative method is a low-risk, minimal invasive alternative method to shunt implantation in adults with SAS.

Adult↗
PubMed1993

[Management of the patient with craniocerebral injuries at the accident site and clinic admission].

Between January 1991 and December 1992, there were 686 rescue operations involving patients with craniocerebral trauma in the catchment area of Ulm. There were 376 patients who had to be graded as seriously injured according to the NACA classification. In 178 cases there was a severe craniocerebral trauma, and 131 of these patients were admitted to the traumatology department of the University of Ulm. The pattern of injuries was analysed; multiple injuries were found in 63 patients, with injuries to the extremities and the thorax being most-frequent. The primary preclinical treatment for patients with craniocerebral trauma is demonstrated; the indications for intubation and artificial respiration are discussed, and also the selection of drugs. Diagnostic procedures and immediate treatment must initially be directed at securing vital functions. Treatment of life-threatening haemorrhage has priority over neurosurgical diagnosis and therapy. The urgent indications for neurosurgical intervention are: space-occupying intracranial bleeding, open craniocerebral traumas, and space-occupying depressed fractures.

Brain Injuries↗
PubMed1993

[Surgical indications in space-occupying contusion hemorrhage].

Traumatic intracerebral haematomas are a common neurosurgical emergency. The role of surgical removal is controversial. The diagnosis and treatment of life-threatening thoracic or abdominal haemorrhage is more urgent than are measures undertaken by the neurosurgeon. In the present paper we report on 318 patients with severe head injury. In 161 cases (38 female, 123 male) CT investigation showed a a resulting from contusion. About a third of each group of patients, both with and without contusion-induced haematomas, were 21-30 years old. The mortality rate was 18.6%. Multiple contusion haematomas occurred in 36%, and solitary ones in 64%. The diagnostic investigations showed contusion haematomas in isolation only in 10.6% of patients. All others had additional injuries: epidural haematomas in 24 cases, subdural haematomas in 29, depressed fractures of the skull in 6, and traumatic subarachnoid haemorrhage in 37. Only 10 patients underwent operative removal of their contusion haematomas by trepanation and 2 others by stereotactic puncture.

Adolescent↗
PubMed1993

[Early and late complications of craniocerebral trauma. Chronic subdural hematoma/hygroma, carotid-cavernous sinus fistula, abscess formation, meningitis and hydrocephalus].

A group of 318 patients suffering from severe head injury, 51 of whom died of their (head) injury, is reviewed. A small contusional cerebral haemorrhage had occurred in 50.6%, and 30% had had basal skull fractures. In the entire group, 2.8% developed posttraumatic hydrocephalus. Shunt implantation was necessary between the 11th and 123rd posttraumatic days (mean 52nd). All patients with inflammatory problems, e.g. meningitis or intracranial abscess, developed posttraumatic hydrocephalus. In 10 of the 12 patients with hygromas, an operative procedure with bur hole trepanation was necessary. Half of the patients with hygromas were polytraumatized but only 25.85% of the entire group. Two patients in the group and a further 49 patients with chronic subdural haematomas were operated on by a bur hole trepanation and appropriate drainage for several days. In 2 cases the development of the chronic subdural haematoma had been documented by CAI. All patients with frontobasal skull fractures were operated on by a transethmoidal approach only the 1st day. Only 2 of the laterobasal skull fractures needed an operation. One of these caused was by a pneumocephalus. In 0.9% of the patients an intracranial abscess was present; these all had a basal skull fracture, 1 after gunshot injury. Among the patients with basal skull fractures 3.1% developed carotid artery-cavernous sinus fistula. One of these three fistulas has been documented as yielding to spontaneous closure. After reangiography for balloon occlusion an aneurysm was found. Following primary operation, 2.5% of patients required revision operation because of renewed bleeding. The posttraumatic treatment of the complications is discussed.

Adolescent↗
PubMed1992

Postoperative spondylodiscitis: results of a prospective study about the aetiology of spondylodiscitis after operation for lumbar disc herniation.

In 412 patients undergoing surgery for herniated lumbar discs from September 1986 to September 1987 and from January 1988 to July 1989 a microbiological specimen was taken from the intervertebral disc space and from the cover of the operating microscope. Also the tips of the wound drains were examined microbiologically after removal. 17% of the patients had a positive bacteriological culture from their intervertebral disc space; 12% of the specimen from the operating microscope were positive. These results favour the hypothesis that intra-operative contamination of the disc space, in contrast to haematogenous spread, causes spondylodiscitis. On the other hand we saw during this time course only one case of clinical spondylodiscitis, which implies a possible involvement of other predisposing factors such as pre- or perioperative infections or compromised patient immunologically. It is also possible, that the routine application of local antibiotic or antiseptic solutions into the disc space at the end of the operation could decontaminate the operative site and prevent clinical infection despite positive culture findings.

Adolescent↗
PubMed1989

[Subarachnoid hemorrhage and intracerebral hematoma in injury of the middle meningeal artery (aneurysma spurium)].

Traumatic lesions of meningeal arteries represent the typical cause of the acute epidural hematoma. Under certain circumstances, however, they may be the origin of space-occupying hemorrhages with only an intradural extent, e.g. subdural or intracerebral hematomas. We present a case of a temporal lobe hematoma with an additional subarachnoid hemorrhage. This gave rise to the suspicion of a spontaneously ruptured cerebral aneurysm that might have caused the patient's accident. Preceding the evacuation of the hematoma, cerebral angiography ruled out the suspected vascular malformation, but revealed a pseudoaneurysm of the middle meningeal artery close to a skull fracture. Intraoperatively, this lesion proved to be the source of the bleeding which was exclusively directed towards the intradural space. Presented is a review of the relevant literature regarding atypical hematomas secondary to meningeal artery lesions and traumatic aneurysms of these vessels.

Adult↗
PubMed1988

Lumbar intervertebral disk herniation with a concomitant nerve root neurinoma at the same site. Case report and review of the literature.

The coincidence of a lumbar disk herniation L4-5 and a neurinoma at the L5 nerve root in a 52-year-old male is reported. The clinical course revealed typical signs of a herniated disk, whereas the tumour was accidentally found by myelography initially performed for the suspected prolapse. Both lesions were removed without complications. The clinical and neuroradiologic aspects of this rare condition are discussed, with special regard to the problems of differential diagnosis. A review of the literature is added.

Humans↗
PubMed1982

[Unusual radiological and clinical findings in a calcified chronic extradural haematoma (author's transl)].

In three of 32 patients with epidural haematomas calcifications and ossifications of the bleeding were found. Quickly developing (3 to 7 weeks) ossifications could be demonstrated by repeated X-rays and CT of the skull in partial drained or untreated haematomas. No ossification could be observed in the remaining 29 cases, in which the haematomas were completely removed. The growth of the ossification from the parietal to the visceral side within the capsules of the haematomas could be monitored in its progress by CT and was histologically verified. The underlying pathological mechanisms are discussed.

Adult↗
PubMed1981

Rupture of an intracranial aneurysm of the carotid artery with ventricular visualization during angiography.

Rupture of an aneurysm during angiography, with extravasation of blood and contrast medium into the ventricular system occurs rarely. We wish to add one personal observation to those few cases already published. Haemorrhage from an aneurysm of the internal carotid artery recurred during angiography in a 52-year-old comatose man. Through extravasation of blood and contrast medium into the ventricles these became fully visible on the X-ray screen. The question of a direct causal relationship between angiography and rupture of an aneurysm, the frequency and risk of this coincidence and mortality are discussed. Since computerised tomography now precedes angiography in cases of subarachnoid haemorrhage, complications arising from angiography could be reduced by proper timing.

Carotid Artery Diseases↗
PubMed1980

[Microsurgical treatment of the lumbar disk herniation (author's transl)].

Meant by the microsurgical treatment of syndromes of lumbar nerve root compression caused by disk herniation, is the simultaneous use of a microsurgical, monosegmental access, and the execution of the operation by means of the operation microscope. Based on our own experience over more than 3 years, we describe the technique of the microsurgical access, as well as the procedure in 67 cases of lumbar disk herniation. The advantages, but also the risks of this surgical method are mentioned, and the indication for microsurgical treatment of lumbar disk herniations is commented on. Advantages are the reduced trauma of the dorsal musculature, and the improved ability to preserve tissue by use of the microscope with it's excellent illumination and magnification of the operation field. Compared with the conventional method, markedly lesser wound pain, as well as rarer micturitional disturbances, are observed postoperatively. Long term results have only been infrequent up to now. There-fore, the microsurgical treatment of lumbar disk herniation, despite it's undeniable advantages, cannot be viewed as an alternative to the hitherto practiced conventional operating methods. In these methods a magnification technique (telescope glasses), focusable light sources and perfectionized instruments can also enable us to keep the operational access restricted.

Adolescent↗