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Biomedical subjects

T Struffert

Publications and source records attributed to T Struffert.

At least 19 recordsLinked to original sources
PubMed2006

Cognitive changes after carotid artery stenting.

INTRODUCTION: We aimed to test changes in cognitive performance after carotid artery stenting (CAS). METHOD: Ten patients were neuropsychologically tested at least 24 h before and 48 h after CAS. To diminish thromboembolic events, we used a proximal protection device. The following neuropsychological tests were selected: The Mini Mental State Examination (MMSE), symbol digit test and subtests of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery (verbal fluency, constructional practice, word list memory and delayed recall). Affective state was determined by the Beck Depression Score (BDS). RESULTS: No patient suffered from depression (BDS <1) or dementia (MMSE 29.9+/-1.5). Nine of the ten patients (P=0.12) showed increased speed in the Number Connection Test (NCT) (corresponding to trail making test). Most patients showed better or similar results concerning delayed recall (P=0.31). No change was observed in the symbol digit test, word list memory, verbal fluency or constructional practice. Better results concerning NCT and delayed recall after carotid stenting might be due to improved brain perfusion. CONCLUSION: After CAS, cognitive and memory performance seem to improve. Further studies with different time intervals and more refined testing, as well as perfusion-weighted imaging, are needed.

Aged↗
PubMed2006

[Vascular anomalies of the cerebellopontine angle].

Vascular anomalies of the cerebellopontine angle are rare compared to tumors in this area. Irritation of the trigeminal, facial, or vestibulocochlear nerve may cause trigeminal neuralgia, hemifacial spasm and vertigo, or tinnitus accordingly. Vessel loops in the cerebellopontine cisterns may cause compression at the root entry or exit zone of the cranial nerves V, VII, and VIII, a phenomenon which is called "vascular loop syndrome." Megadolichobasilar artery and aneurysms of the vertebrobasilar system can also lead to dislocation and compression of the cranial nerves and brain stem. Three-dimensional CISS MR imaging and MR angiography are useful in the detection of neurovascular compression. Microvascular decompression is an effective surgical procedure in the management of compression syndromes of the cranial nerves V, VII, and VIII.

Aged↗
PubMed2005

[Intra-arterial thrombolysis of the middle cerebral artery: an overview].

Until 1996, treatment of strokes consisted exclusively of efforts to prevent recurrence. The development of intravenous and intra-arterial thrombolysis changed the approach to a causal therapy. This article provides an overview of state-of-the-art intravenous and intra-arterial therapeutic concepts and attempts to define the position of the local intra-arterial fibrinolysis approach.

Fibrinolytic Agents↗
PubMed2005

[Thrombolysis of the basilar artery: 5-year results from the Saarland stroke registry].

Acute thrombosis of the basilar artery has a fatal outcome if left untreated. The relatively good prognosis with intra-arterial thrombolysis makes it the therapy of choice for acute basilar thrombosis. In the Saarland stroke registry, we analyzed 47 patients with angiographically proven basilar artery thrombosis within the last 5 years. We observed a better outcome in patients with good income, with recanalization, and a short time between onset of symptoms and start of thrombolysis. The complications, such as intracerebral bleedings, occurred only in the group treated with rt-PA. Intra-arterial thrombolysis with urokinase or rt-PA is a relatively safe therapy, but should be performed in neuroradiological centers. With progressing symptoms the therapeutic window can be stretched up to 12 h, but coma lasting for more than 4 h is related to a bad outcome.

Acute Disease↗
PubMed2005

[Imaging diagnostics of the pharynx and larynx].

The pharynx and larynx represent very sophisticated regions and may be involved in a diverse range of pathologic conditions. Evaluation of the head and neck has developed significantly with the establishment of CT and MRI as they provide true insights into the endoscopically blind areas as well as depth of tumor infiltration, its submucosal growth and contralateral involvement, cartilage invasion, bone marrow invasion, and nonpalpable adenopathy. Inflammations in the head and neck region are only exceptionally imaged with CT or MRI; indications are the diagnosis of retrotonsillar and parapharyngeal abscesses and ensuing complications. The different imaging modalities of malignant pharyngeal and laryngeal tumors and their differential diagnosis are presented in this paper.

Angiography, Digital Subtraction↗
PubMed2005

[Imaging of the temporal bone. An overview].

Diseases of the temporal bone should be diagnosed by high resolution computed tomography (CT) and magnetic resonance imaging (MRI). Because of the excellent imaging of bony structures, CT is the method of choice for diagnosing pathologies of the external auditory channel, middle ear, and mastoid. Imaging of trauma is performed with CT. For examining the labyrinth system and interior auditory channel, MRI is the method of choice. This article gives an overview of the anatomy of the temporal bone and describes the most important pathologies.

Diagnosis, Differential↗
PubMed2005

[Reliability of quantifying vascular white matter brain lesions -- a contribution to reproducible quantitative diagnosis].

PURPOSE: Microangiopathic lesions of the brain tissue correlate with the clinical diagnosis of vascular subcortical dementia. The "experience-based" evaluation is insufficient. Rating scales may contribute to reproducible quantification. MATERIALS AND METHODS: In MRI studies of 10 patients, 9 neuroradiologists quantified vascular white matter lesions (WMLs) at two different points in time for 12 anatomically defined regions with respect to number, size and localization (score). For 9 observers and 10 studies, 90 intra-observer differences were obtained for each of the 12 WML scores. To calculate the inter-observer reliability, rating pairs were formed. Furthermore, 360 differences were computed for each score and rating for 12 anatomically defined WML scores, and the intraclass correlation (ICC) was calculated as a measure of agreement (reliability). RESULTS: As to the intra-observer reliability, the median of the differences was 1.5 for the entire brain as opposed to 0 for defined brain regions. The corresponding values for the inter-observer reliability were 3 and 1, respectively. The mean intra-class correlation coefficient for the 10 studies was 0.88, whereas the mean interclass correlation concerning the inter-observer reliability was 0.70, with the first and second rating being averaged. The rating of each study took about 6 minutes. CONCLUSION: The rating scale with high intra- and inter-observer reliability can dependably quantify WMLs and correlates with the clinical diagnosis of vascular dementia. Using a reliable rating scale, the diagnostic distinction of age-associated physiological vs. pathological size of the WML can make a contribution to the reproducible quantifiable diagnostic evaluation of vascular brain tissue lesions within the framework of dementia diagnostics.

Aged↗
PubMed2004

[Proximal protection systems using carotid artery stent].

Controversies as to whether or not a protection device should be used in carotid artery stenting exist. Currently three temporary cerebral protection devices are being used. These are devices with distal balloon occlusion or filtration baskets and proximal occlusion devices with flow reversal in the internal carotid artery. This article focuses on flow reversal systems and aims to give some advice as to which patients could benefit from their use.

Angioplasty, Balloon↗
PubMed2004

[Treatment of arteriosclerotic carotid stenosis: an overview].

Endarterectomy for extracranial carotid stenosis has proven to be the method of choice for symptomatic patients suffering from ischemia (NASCET, ECST). The effectivity of the operation for asymptomatic stenosis seems to be likely since the publication of the first results of the ACST trial. The safety and efficiency of carotid stenting has not been proven so far and has to be evaluated in randomized trials comparing surgery and endovascular treatment. We provide an overview of the current trials and try to define the role of carotid stenting.

Angioplasty, Balloon↗
PubMed2004

[Technique and approach to carotid stenting].

Assuming that the ongoing large randomized controlled trials comparing CAS and endarterectomy support the efficacy and safety of CAS, this method will play a major role in patients with carotid stenosis in the near future. Patient selection, establishing standards of treatment, and systematic training of the interventionist are major issues. This article aims to give an overview of current techniques and devices available in CAS.

Angioplasty, Balloon↗
PubMed2004

[Spinal intradural tumors].

Spinal intradural tumors are uncommon lesions but may cause significant morbidity. In establishing the differential diagnosis for a spinal lesion, location, age, and the patient's clinical presentation are important. Magnetic resonance imaging plays a central role in the visualization of spinal tumors, easily allowing tumors to be classified as extradural, intradural extramedullary, or intramedullary which is very useful in tumor characterization. We describe intradural tumors; the majority is extramedullary, with nerve sheath tumors being the most frequent. Intramedullary tumors are uncommon spinal tumors. Ependymomas and astrocytomas comprise the majority of this group. Typical imaging features of both intradural extramedullary and intramedullary tumors are described.

Humans↗
PubMed2003

[Brain and head injury. Part 1: Clinical classification, imaging modalities, extra-axial injuries, and contusions].

This article describes the imaging tools for efficient diagnostic management of head trauma victims. The basic mechanisms of brain injuries are explained and the imaging features are described. Computed tomography remains the most important method for the initial screening and follow-up investigation. Though magnetic resonance imaging has a higher sensitivity to most traumatic lesions, it does not play an important role in the acute phase of head trauma patients. In the first part of this paper clinical classifications, imaging modalities, extra-axial injuries, and contusions are described. In the second part of this paper intra-axial and secondary injuries are discussed.

Brain↗
PubMed2003

[Craniocerebral trauma in childhood].

This article describes typical head injuries in infants and children. In comparison with adults there are distinct differences in the etiology of trauma and in the kind of reaction of the skull and brain. In infants and children there are three different types of trauma: birth trauma, accidental and non-accidental injury. The typical injuries in these three groups are described.

Cerebral Hemorrhage, Traumatic↗
PubMed2002

Virtual endoscopy combined with intraoperative neuronavigation for planning of endoscopic surgery in patients with occlusive hydrocephalus and intracranial cysts.

We assessed the clinical value of MR ventriculoscopy (virtual endoscopy, VE) combined with image-guided frameless stereotaxy for endoscopic surgery of occlusive hydrocephalus and intracranial cysts. VE was obtained in 20 patients with hydrocephalus and three with intracranial cysts. All surgical operations were endoscopic. The path of the rigid endoscope to the target point was planned using neuronavigation. VE was carried out along the same trajectory retrospectively in 20 cases and prospectively in three. The results were analysed for demonstration of anatomical landmarks and structures at risk. VE was successful in all patients. Possible obstacles to endoscopic access to the lamina terminalis and the basal cisterns and structures at risk, such as the basilar artery, were clearly shown in relation to the direction of the endoscope. However, the floor of the third ventricle and septum pellucidum were not clearly seen and possible abnormalities could therefore not be appreciated. VE can provide realistic simulation of endoscopic third ventriculostomy and cystostomy. The appropriate trepanation point and trajectory of the endoscope can be assessed with regard to the size of the foramen of Monro and the position of vulnerable structures. This simulated trajectory can be adapted to the field of operation by image-guided neuronavigation. This regime may potentially reduce the risk of damage to intracranial structures.

Adolescent↗