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Biomedical subjects

R H Bartels

Publications and source records attributed to R H Bartels.

At least 19 recordsLinked to original sources
PubMed2001

History of the surgical treatment of ulnar nerve compression at the elbow.

OBJECTIVE: Surgery to achieve ulnar nerve decompression at the elbow has been performed for nearly 2 centuries. Several methods have been developed, some of which have been abandoned. Historical insight improves understanding of current techniques and provides the basis for the development of new methods. Which treatment method is best is the topic of ongoing debate. METHODS: The literature was reviewed using the MEDLINE database. Standard textbooks and retrieved articles were checked for missing references. For older articles, the bibliographies of books and theses were consulted. When I was unsuccessful in finding information in standard biographies of authors of milestone publications, I contacted the hospitals or institutions in which these individuals worked or are currently working. RESULTS: A systematic chronological overview of the surgical treatment of ulnar nerve compression at the elbow is presented, with special attention to people who described a treatment method for the first time. CONCLUSION: This article is the first in the literature to provide information about and photographs of nearly all of the people who were important in the development of the surgical treatment of compression of the ulnar nerve at the elbow.

Cubital Tunnel Syndrome↗
PubMed2001

Height of cervical foramina after anterior discectomy and implantation of a carbon fiber cage.

OBJECT: The authors evaluate the effects of implantation of a carbon fiber cage after anterior cervical discectomy (ACD) on the height of the foramen and the angulation between endplates of the disc space. METHODS: Thirteen consecutive patients who were scheduled for standard microscopic ACD and interbody fusion underwent thin-slice (1.5 mm) spiral computerized tomography scanning 1 day preoperatively, 1 day postoperatively, and 1 year postoperatively. Oblique sagittal reconstructions were made through both foramina; the height of each foramen and the angle between the endplates were measured. Because 16 cages were implanted, 32 foramina were investigated. Preoperatively, the mean height of the foramina (+/- standard deviation) was 8.1 +/- 1.5 mm (range 5.7-12 mm), and at I day postoperatively it was 9.7 +/- 1.4 mm (range 7.5-12.8 mm). This difference reached statistical significance (p < 0.0005). The mean foraminal height after 1 year was 9.4 +/- 1.4 mm (range 6.9-12.7 mm). In terms of the preoperative value, the 1-year measurement still reached statistical difference (p < 0.005) but not with the direct postoperative mean foraminal height. Preoperatively the mean value of the angle between the two adjacent endplates was 1.3 +/- 2.4 degrees (range 0-8 degrees), and postoperatively it was 7.8 +/- 2.9 degrees (rauge 2-12 degrees), which was statistically significant (p < 0.0005). CONCLUSIONS: The cervical carbon fiber cage effectively increased the height of the foramen even after 1 year, which contributed to decompression of the nerve root. The wedge shape of the device may contribute to restoration of lordosis.

Adult↗
PubMed2000

[Cavernous sinus syndrome].

A clear and concise description and clinical interpretation of the cavernous sinus syndrome are lacking. Pathological changes in or around the cavernous sinus may lead to failure of eye muscle nerves and of one or more branches of the trigeminal nerve. The clinical signs of the cavernous sinus syndrome are combinations of failure of these cranial nerves sometimes with exophthalmus. Because many nerves can be wholly or partially involved in the syndrome, there is no clinical uniformity and the cavernous sinus syndrome has never been well defined. A neurotopographical classification is proposed in order to simplify the multiple interpretations of the cavernous sinus syndrome. The classical cavernous sinus syndrome is divided into three syndromes: the syndrome of the superior orbital fissure, the syndrome of the lateral wall of the cavernous sinus and the central cavernous sinus syndrome.

Cavernous Sinus↗
PubMed2000

Spinal arachnoiditis following subarachnoid haemorrhage: report of two cases and review of the literature.

Two patients with spinal arachnoiditis following subarachnoid haemorrhage are described. A complete spinal block was seen at the mid thoracic level with characteristics of spinal arachnoiditis. Only one patient had severe symptoms. Both patients were treated conservatively. Signs and symptoms diminished in time. A review of the literature is given and the aetiology is discussed.

Aged↗
PubMed1999

Surgical approach and histoanatomical aspects of the oculomotor nerve in rats.

The surgical approach and some histoanatomical characteristics of the intracavernous portion of the oculomotor nerve are described. Moreover, some perioperative precautions for intracranial surgical procedures in the rat are reported and the suitability of the rat as a model for studying intracranial nerve regeneration is discussed. With the data provided, this model of oculomotor nerve approach can be used to study various aspects of intracranial nerve regeneration.

Animals↗
PubMed1999

End-to-end versus peripheral nerve graft repair of the oculomotor nerve in rats: A comparative histological and morphometric study.

A comparative study was undertaken to evaluate end-to-end versus peripheral nerve graft repair in cranial nerve reconstruction. In 14 rats, the oculomotor nerve was sharply transected in the cavernous sinus and repaired either by end-to-end coaptation (n = 7) or by interposition of a peripheral nerve graft (n = 7). The results were evaluated 16 weeks after surgery by light and transmission electron microsurgery and by morphometric analysis. The degree of neuroma formation, fibrosis, and axonal disorganisation at the repair site was the same for both groups. Histologically, both end-to-end and graft repair groups revealed various degrees of axonal regeneration with myelinated nerve fibres in the distal nerve segments. In both groups, the number of nerve fibres distal to the repair site was increased compared to proximal to the repair (P < 0.001) but myelinated axon diameter was significantly less than that of control nerves (P < 0.001). No difference existed between the two repair groups in terms of mean myelinated axonal diameter. However, the number and density of myelinated axons was statistically greater in the graft group (P < 0.05). In conclusion, despite the disadvantage of two repair sites, peripheral nerve grafting results in equal or slightly superior axonal regeneration compared to an end-to-end repair in the rodent model of intracranial oculomotor nerve reconstruction. We speculate that this may be due to the structure of the peripheral nerve graft.

Animals↗
PubMed1999

A new technique for the assessment of the draining area of a cerebral vein.

BACKGROUND: At present, it is not exactly clear which vein is allocated for drainage of blood to a particular area of the human brain. Knowledge of these draining areas is very important for the understanding of occlusive venous diseases. A method was developed that offers the possibility to investigate the draining area of a cerebral vein, with the help of an animal model. METHODS: Brains of sacrificed rabbits are removed and are anterogradely perfused with a coloring matter. Then a vein chosen at random is occluded and anterograde perfusion is restarted using another coloring substance. The working hypothesis is that the part of the brain that is solely dependent for its drainage of blood upon the occluded vein (the draining area of the vein) will show a deficit in staining after the second perfusion. RESULTS Using the abovementioned technique, no filling defect was seen if a vein was occluded near its entrance into the sinus (N = 8) or at a single point over the cortex (N = 7). If a longer trajectory (10-14 mm.) was obstructed, a clear staining defect was seen in 13 out of 16 hemispheres; the three remaining cases seemed to be technical failures. CONCLUSION: A new method is described to investigate the draining area of a cerebral vein. Although the validity of the method is proven in an animal model, it seems a good technique for investigation of human brains postmortem. Application of this technique will contribute to the understanding of the pathophysiology of venous diseases and also elucidate the role of the venous anastomotic pathways.

Animals↗
PubMed1999

Endoscope-assisted supraorbital craniotomy for lesions of the interpeduncular fossa.

OBJECTIVE: The supraorbital approach is well accepted for lesions in the anterior fossa, the sellar region, and the anterior circle of Willis. However, the usefulness of this approach has not yet been elucidated for lesions in the interpeduncular fossa. The technique of an endoscope-assisted, ipsi- and contralateral supraorbital approach to lesions within the interpeduncular fossa is described, and the initial results are reported. METHODS: A small supraorbital craniotomy, using an eyebrow incision, was performed in each of seven patients who were operated on for different types of lesions in the interpeduncular fossa, including a neuromuscular choristoma of the oculomotor nerve, a retrosellar epidermoid tumor, and five aneurysms (two of the basilar artery tip, two at the offspring of the superior cerebellar artery, and one fusiform arterial widening of the basilar artery apex). The surgical approach, its indications and limitations, and the additional value of an endoscope are outlined. RESULTS: All lesions could be easily reached and well visualized through this approach by using an endoscope as an adjunct to the operating microscope. The saccular aneurysms all could be clipped successfully, the fusiform widening was wrapped, the epidermoid tumor was removed completely, and the choristoma was removed only partially because of brain stem invasion. The patient with the neuromuscular choristoma had persistent diabetes insipidus postoperatively, most probably caused by stretching the pituitary stalk with the endoscope. The patient with the epidermoid tumor showed a postoperative transient partial oculomotor nerve paresis at the side of the approach. The cosmetic results of the eyebrow incisions for this approach were excellent in all patients. CONCLUSION: Lesions in the interpeduncular fossa can be effectively treated using a supraorbital approach, which can be ipsi- or contralateral to the side of the lesion, depending on the exact location of the lesion. The use of an endoscope is essential to visualize these lesions that lie in the shadow of the sellar and parasellar anatomic structures. The major advantage over other approaches are a nearly perpendicular surgical route (although the distance is longer, which is, on the other hand, not a disadvantage), a minimized amount of dissection and brain retraction by using an endoscope through anatomic gateways, and a small surgical incision with excellent cosmetic results.

Adult↗
PubMed1999

Stabilization and accurate trimming of nerve ends: practical use of fibrin glue: technical note.

OBJECTIVE: Peripheral nerve transection usually results in protrusion of the endoneurial contents ("mushrooming"). Trimming of the nerve ends before repair is often necessary to achieve cut nerve end planes. In this technical report, we describe a technique for stabilization and accurate trimming of nerve ends using fibrin glue. SURGICAL TECHNIQUE: The nerve ends of divided peripheral nerves are coated with fibrin glue and subsequently trimmed using a razor blade before repair. RESULTS: When fibrin glue is applied, a firm layer with a rubbery consistency is formed around the nerve. This layer stabilizes the nerve ends during trimming, and a clear-cut plane of the nerve can be achieved. Moreover, the fibrin glue stabilizes the nerve ends during manipulations caused by suturing of the nerve. CONCLUSION: The technique results in easier handling of the nerve during trimming and manipulation, minimal tissue damage to the nerve, and a clear-cut plane of the nerve.

Fibrin Tissue Adhesive↗
PubMed1998

A giant cell tumor of the sacrum or a soft tissue giant cell tumor? A case report.

STUDY DESIGN: A case report. OBJECTIVE: Giant cell tumors are rare primary bone tumors. Generally, these tumors are expanding osteolytic lesions, but soft tissue giant cell tumors can occur. This is a case report of an unusual incidence of a giant cell tumor within the spinal sacral canal, in which there was no involvement of the surrounding bone or ligament structures and that was signaled by radicular pain. The pathologic course of the tumor is described. SUMMARY OF BACKGROUND DATA: A 24-year-old woman had monoradicular pain in the right leg in the region of S2. Neuroradiologic examination showed a mass within the sacral spinal canal compromising the right S2 root, with no sign of bone involvement. METHODS: A sacral laminectomy was performed. A tumor was located entirely intraspinally and extradurally and was removed completely. A giant cell tumor was identified in histologic examination. RESULT: The patient recovered completely. No local regrowth or metastasis occurred during a 20-month follow-up. CONCLUSION: The treatment of choice in giant cell tumors is complete surgical resection. Radiotherapy is recommended in cases of subtotal resection. Careful follow-up is warranted, because recurrence and metastasis are not uncommon.

Adult↗
PubMed1998

Familial congenital hydrocephalus and aqueduct stenosis with probably autosomal dominant inheritance and variable expression.

A kindred is reported on with suspected autosomal dominant congenital hydrocephalus and aqueduct stenosis. In contrast to patients with X-linked congenital hydrocephalus with stenosis of the aqueduct of Sylvius (HSAS) our patients were not mentally retarded and they did not show any pyramidal tract dysfunction or clasped thumbs; the pyramids were not affected either, as was confirmed by autopsy, CT or MRI. Molecular genetic studies in our patients have not revealed abnormalities of eight exons of the L1 neural adhesion molecule gene that is related to HSAS.

Adult↗
PubMed1998

Surgical management of ulnar nerve compression at the elbow: an analysis of the literature.

OBJECT: Surgical treatment for cubital ulnar nerve compression includes medial epicondylectomy, simple decompression, or anterior transposition (subcutaneous, intramuscular, or submuscular). There is a dearth of prospective randomized studies on which to base guidelines for choosing one operative treatment over another. The authors review the literature on this subject and present their findings. METHODS: The authors reviewed the literature from January 1970 to July 1997. Two authors decided independently whether an article should be included for review based on previously formulated inclusion and exclusion criteria. In addition to demographic information, data concerning preoperative status and outcome were extracted. For statistical analyses chi-square and Kruskal-Wallis tests were performed. Irrespective of their preoperative status, patients with simple decompression had the best outcome, whereas those with anterior subcutaneous and submuscular transposition had the worst. If outcome was related to the patient's preoperative status, a significant difference was not found among the various groups for those patients with a preoperative McGowan Grade 2. However, for those with McGowan Grade 3 (severe) symptoms, patients with anterior intramuscular transposition had the best outcome followed by those with simple decompression and anterior submuscular transposition. Statistical analysis was not possible for patients with McGowan Grade 1 because of the small numbers of patients in several treatment modality groups. CONCLUSIONS: Formulating a uniform guideline for operative treatment is not possible based on the results of this study. However, the authors believe that support is given to their policy, which is primarily to perform a simple decompression. Its surgical simplicity with preservation of the anatomy, especially the vascularization, and the possibility of rapid postoperative rehabilitation are also taken into consideration. If subluxation is found intraoperatively, anterior transposition is proposed.

Elbow↗
PubMed1998

Falcine sinus and occipital encephalocele: a magnetic resonance venography study.

OBJECT: Occipital encephaloceles are relatively frequently encountered. Many investigators have addressed the embryogenesis of these formations, but the dural system has never before been studied. In this retrospective analysis the authors sought to gain a better understanding of the origins of these defects. METHODS: The charts and radiological examinations, especially the magnetic resonance venography studies, were reviewed in seven patients. In six patients the straight sinus was absent. Drainage of the galenic system took place through a sinus within the falx, also known as a falcine sinus. The tentorium was not seen in five patients. CONCLUSIONS: The combination of an absent straight sinus and dysplastic tentorium is no coincidence: both develop within the same mesenchyme in the mesencephalic flexure. Distortion of the mesenchyme by a neural tube defect, causing an occipital encephalocele, will lead not only to disorders of the tentorium but also of the straight sinus.

Adult↗
PubMed1997

Lumbar cerebrospinal fluid drainage for symptomatic sacral nerve root cysts: an adjuvant diagnostic procedure and/or alternative treatment? Technical case report.

OBJECTIVE AND IMPORTANCE: The treatment of symptomatic sacral nerve root cysts is difficult and challenging. A major role has been ascribed to the hydrostatic and pulsatile forces of cerebrospinal fluid (CSF) for the symptomatology of sacral nerve root cysts. Theoretically, lowering those pressures should have a beneficial effect on the symptoms. Lowering the hydrostatic and pulsatile pressures may be achieved by lumbar CSF drainage. The effect of lumbar CSF drainage on the symptomatology of sacral nerve root cysts is described. CLINICAL PRESENTATION: Three patients suffered from leg and/or low back pain as a result of sacral nerve root cysts. INTERVENTION: First, CSF was drained through an external lumbar drain that was connected to a CSF bag. Mobilization was not restricted. All patients became free of symptoms. Eventually, a lumboperitoneal shunt was inserted in two patients. Those two patients remained free of complaints for 11 and 9 months, respectively. CONCLUSION: To our knowledge, this is the first report that clearly establishes the role of CSF forces in the symptomatology of sacral nerve root cysts. Lumbar external CSF drainage is a diagnostic tool to investigate the clinical significance of sacral nerve root cyst(s). Lumboperitoneal CSF shunting is a promising alternative in the treatment of symptomatic sacral nerve root cysts.

Back Pain↗
PubMed1997

Intraoperative dislocation of the distal lens of a neuroendoscope: a very rare complication: technical case report.

OBJECTIVE AND IMPORTANCE: A very unusual complication of neuroendoscopy that was caused by equipment failure is described. CLINICAL PRESENTATION: Intraoperatively, the distal lens of a reusable rigid, lenscope-type neuroendoscope became dislodged. Fortunately, this did not have any adverse consequences for the patient. DISCUSSION: The cause remains obscure but probably relates to the repeated use of the scope. Perhaps the use of a disposable neuroendoscope could have prevented this, but reusable lenscopes are designed to be used many times. CONCLUSION: The risk of such equipment failure should be weighed against the distinct advantage of a much clearer image than is provided by fiberscopes.

Cerebral Ventricles↗
PubMed1997

Occipitotranstentorial approach for lesions of the superior cerebellar hemisphere: technical report.

OBJECTIVE: The occipitotranstentorial approach is well accepted for lesions of the pineal region, superior cerebellar vermis, or mesencephalon. Although evidently suitable, this approach has not, to our knowledge, been reported for lesions of the superior cerebellar hemisphere in adults. Experience with this approach is reported. METHODS: Four patients underwent surgery between August 1995 and March 1997. The findings obtained are evaluated. RESULTS: All lesions were situated in the quadrangular lobules (one extending into the vermis), and all were completely removed. Postoperative deficits, especially visual field deficits, did not occur. CONCLUSION: Lesions of the superior cerebellar hemispheres are easily approached by an occipitotranstentorial route. The major advantages over a supracerebellar approach are that the surgical route is nearly perpendicular to the lesion and to the tentorium instead of parallel, and wide exposure is thereby possible.

Adult↗