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Biomedical subjects

U Ebeling

Publications and source records attributed to U Ebeling.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Neurosurgical treatment of lumbar stenosis. A review of the literature].

Low back pain and claudicatio spinalis are typical for spinal stenosis. Neuroradiological diagnosis is best accomplished by a myelogram. The operative results in patients with a lumbar spinal canal stenosis are successful in 85.5%. Radicular pain responds better than lumbar pain. Severe complications such as new persistent neurological deficits are rare. If the operation is performed early the results are usually better than with delayed surgery. The decompression should be adapted to the type and extent of the stenosis. Additional removal of the disc as well as severe damage to the facet joints increases the risk of postoperative instability.

Follow-Up Studies↗
PubMed1991

[Mapping in tumor surgery of the central region].

A prerequisite for successful operations of the central area is the exact pre- and intraoperative localization of the motor strip and the pyramidal tract. The craniocerebral landmarks--the coronal suture and bregma--and the central anatomy in the CT and the MRI favors their localization. According to the anatomical variations and the displacement of the brain by the lesion, these landmarks are not very reliable in identifying the central region in all cases. A safe intraoperative localization of the motor strip is possible with the combination of electrical cortical stimulation and recording of somatosensory evoked potentials. With these methods the results of operations of central lesions are good and the risk of severe postoperative morbidity is low.

Adult↗
PubMed1990

Early prognosis of supratentorial grade 2 astrocytomas in adult patients after resection or stereotactic biopsy. An analysis of 50 cases operated on between 1984 and 1988.

50 adult supratentorial low-grade astrocytomas operated upon between 1984 and 1988 were analysed retrospectively with respect to postoperative condition and progression-free survival. Pilocytic lesions were excluded. In 32 instances the tumour was macroscopically completely removed and partially in 4. In 14 cases a stereotactic biopsy was performed only. 10 patients received postoperative radiotherapy with 55 to 65 Gy. 1 patient died perioperatively from pulmonary embolism. 39 patients could resume their previous activities after discharge from the hospital, 10 were significantly disabled by neurological deficit, reduced neuropsychological performance or medically intractable epilepsy. Postoperatively, most patients required continuous anti-epileptic medication, 10 recurrences or tumour progressions of incompletely removed or merely biopsied lesions were observed within the mean follow-up period of 22 months. All recurrences after gross total removal, that were reoperated, had progressed to a malignant glioma. Of the prognostic tumour characteristics analysed, a histologically well-delineated tumour demarcation was most clearly associated with a favourable prognosis. Concerning treatment modalities, gross total resection was associated with a favourable prognosis. Radiotherapy was associated with an unfavourable outcome but this is probably due to selection of otherwise unfavourable cases.

Adolescent↗
PubMed1990

Sulcus topography of the parietal opercular region: an anatomic and MR study.

The study describes the sulcal and gyral topography, variability, and left-right asymmetry of the parietal operculum. Eighty postmortem hemispheres as well as sagittal magnetic resonance images from 20 health volunteers (40 hemispheres) were evaluated. Four different types of parietal opercular sulcus topography were recognized. Most frequently, and conforming with the anatomic "textbook pattern", the inferior postcentral sulcus (POCS) is the sulcus anterior to the posterior ascending ramus (PAR) of the Sylvian fissure (type 1). Variations were the following: lack of a PAR (type 2), interposition of an intermediate opercular sulcus and gyrus between PAR and POCS (type 3), and direct transition of PAR into POCS with subsequent lack of a classical supramarginal gyrus (type 4). Inconstancy of the sulcal standard arrangement was especially pronounced among left hemispheres, where the patterns differed from type 1 in one third of the cases. Types 2 and 3 were significantly more frequent in left hemispheres, whereas type 4 occurred significantly more frequently in right hemispheres. Upon intraindividual left-right comparison, a remarkable 38% of the brains showed gross asymmetry of the parietal opercular sulcus patterns, characterized by a left type 2 or 3 and/or a right type 4; another 5% exhibited a reverse type of asymmetry. The findings supplement previous data on gross variability and left-right asymmetry of the posterior Sylvian fissure and its lower bank. They indicate that the Sylvian fissure is an unreliable landmark with respect to inferior parietal structures especially in left hemispheres. Individual mapping of perisylvian topography may contribute to studies on structural-functional relationship.

Adult↗
PubMed1990

[Stereotaxic brain puncture. Indications and results].

228 stereotactic biopsies for the diagnosis of brain lesions were evaluated. In 98.2% a diagnosis could be established. The diagnosis was made of brain tumor in 79.3%, of brain abscess in 7.5% and of encephalitis in 3.5% of cases. In 2.2% of the patients a pathological finding was obtained without a clear histological definition. No histological diagnosis could be made in 1.8% of the patients. A severe complication of brain biopsy occurred in 2.2% of the patients (1 death, 1 abscess, 3 increased impairments). The stereotactic procedure appears to have a low mortality and morbidity, and to be highly accurate.

AIDS Dementia Complex↗
PubMed1990

[Extreme lateral lumbar intervertebral disk displacement. Incidence, symptoms and therapy].

Upper lumbar nerve root compression or a femoralgia is often caused by extreme lateral lumbar disc herniation. This type of lumbar disc herniation compresses the nerve root inside or laterally to the intervertebral canal, while mediolateral disc herniations squeeze it in the lateral recess. Pain radiating obliquely over the thigh is the dominant clinical symptom. Bending the body to the ipsilateral side usually increases the pain. When neurologic signs are present, motor deficits tend to be more prominent than sensory and the deficits never affect more than one nerve root. Most frequently a weakness of knee extension occurs.

Humans↗
PubMed1989

Tumour-surgery within the central motor strip: surgical results with the aid of electrical motor cortex stimulation.

Surgery of tumours within or close to the central motor area always carries the risk of a new or increased postoperative motor deficit. One reason may be the difficulty of localizing the sensorimotor region, when it is displaced or distorted by the tumour and the perifocal oedema. Recently anatomical data of the craniocerebral topography of the central sulcus became available. We safely used under general anaesthesia the intraoperative mapping of the motor cortex by direct cortical electrical stimulation. In 21 patients tumours adjacent to or within the motor area were microsurgically resected. As a result of intraoperative localization the surgical approach had to be modified in contrast to the preoperative localization of the lesion in 5 patients. No new or increased motor deficit occurred and in some cases the preoperative weakness was reduced remarkably.

Adult↗
PubMed1989

Pedicle origin and intervertebral compartment in the lumbar and upper sacral spine. A biometric study.

The osseous boundaries of the intervertebral compartment are described. Measurements of the pedicles demonstrate that their configuration determines the shape of the intervertebral compartment. The pedicles originate in the upper lumbar spine (L 1 and L 2) in a vertical direction from the posterior aspects of the vertebral bodies. In the caudal lumbar spine (L 4 and L 5) the origin of the pedicles is more oblique and thereby moves much more laterally and ventrally. As a consequence the horizontal extension of the pedicles is increasing in the lower lumbar spine. In the upper lumbar region the intervertebral compartment corresponds more to a foramen, in the lower lumbar spine more to a canal. The resulting clinical relevance for the length of the intervertebral compartment and the nerve root course is discussed.

Adult↗
PubMed1989

Topography and identification of the inferior precentral sulcus in MR imaging.

Sagittal MR imaging was used to investigate cerebral sulci bordering the functionally important areas on the lateral suprasylvian surface. The aim of the study was to identify characteristic relationships of the inferior precentral sulcus to nearby sulci and gyri. MR findings in 20 healthy volunteers were compared with those in 62 intact postmortem hemispheres. MR techniques are described for the direct identification of the anterior ascending ramus of the sylvian fissure and the inferior precentral sulcus. These sulci, which border Broca's area and the primary motor area, can be reliably identified with sagittal MR. Four different types of sulcus topography were recognized. Most frequently, the inferior precentral sulcus is the sulcus posterior to the anterior ascending sylvian ramus (95% in the MR study, 87% in the anatomic study). Occasionally, an additional sulcus is interposed (5%, 10%), or an ascending ramus is absent (0%, 3%). Identification of these landmarks is important for the exact preoperative localization of cortical lesions as well as for the intraoperative interpretation of individual sulcus patterns.

Adult↗
PubMed1989

Microsurgical reoperation following lumbar disc surgery. Timing, surgical findings, and outcome in 92 patients.

Ninety-two patients who underwent microsurgical reoperation for persistent or new complaints following initial lumbar intervertebral disc surgery were evaluated retrospectively. Sixty percent of all pain relapses occurred within 1 year following the first operation; thereafter, the probability of a relapse declined steadily and was as low as 0.1% per year between 5 and 20 years. The results of microsurgical reoperation in terms of pain relief and working capability were considered "excellent" in 22% of patients, "good" in 30%, and "satisfactory" in 29%. Thus, 81% of the patients could be considered as treated successfully and in 19% the result was not successful. The most common intraoperative findings were: a true recurrence at the same level in 43% of cases, a new herniation at another level in 15%, and a small recurrent fragment embedded in epidural fibrosis in 23%. Five percent of patients had severe epidural fibrosis as the only pathology. In 15%, reoperation was performed within 1 month to treat persisting pain, and either a missed disc fragment, an inadequately decompressed lateral recess, or an unrecognized second-level disc protrusion was found. The clinical outcome is affected predominantly by the intraoperative pathology and the time interval between the first and second operation. An excellent or good outcome was usually achieved in patients with a recurrence of pain after 1 year resulting from a true recurrent disc or a new herniation at another level. In contrast, very unfavorable results were noted with most reoperations performed during the 1st year when extensive epidural fibrosis (or fibrosis with a small recurrence) was present.

Adult↗
PubMed1988

Neurosurgical topography of the optic radiation in the temporal lobe.

Damage to the optic radiation during surgery in the temporal lobe results in more or less severe visual field defects. In the present study, the optic radiation was represented by either Klingler's fibre dissection technique or by consecutive frontal sections respectively in 25 formalin-fixed human hemispheres. This enabled one to gain exact data on the three-dimensional course, the length and other measurements of this important fibre system. In addition, its relations to the temporal horn, the trigonum and the occipital horn of the lateral ventricle were determined. The results of these measurements are discussed with respect to various surgical interventions involving the temporal lobe.

Autopsy↗
PubMed1988

Outcome of aneurysmal subarachnoid hemorrhage in a hospital population: a prospective study including early operation, intravenous nimodipine, and transcranial Doppler ultrasound.

A total of 153 consecutive patients with proven aneurysmal subarachnoid hemorrhages (SAHs) admitted immediately after diagnosis regardless of clinical condition were managed according to the same protocol. The initial evaluation included computed tomography (CT), transcranial Doppler ultrasound (TCD), angiography-CT, and/or angiography. Intravenous nimodipine (2 mg/hour) was started after confirmation of the diagnosis. The timing of operation was determined individually according to age, clinical course, and CT and TCD findings. Twenty-one Grade V patients treated with intensive care and ventriculostomy died or did not improve within 24 hours after SAH. Three patients with life-threatening intracerebral hematomas underwent emergency operation. Operation was early in 55 good risk patients and late in 57 patients because of poor initial grade, late admission, or logistic reasons. Seventeen patients had no operation because of old age, persistent poor clinical condition, medical complication, or lethal rebleeding before operation. In the total series, 90 patients (59%) made a full recovery, the overall morbidity rate was 14% (21 of 153 cases), and the mortality rate was 27% (42 of 153). Postoperative mortality including emergency evacuation of hematomas was 7.8% and mortality after elective operation was 6.2%. The causes of disability and death were the initial effect of the hemorrhage in 25 patients (16.3%), rebleeding in 15 (9.8%), delayed cerebral infarction in 8 (5.2%), surgical complications in 7 (4.5%), hydrocephalus in 4 (2.6%), and medical complications in 4 (2.6%).

Adolescent↗
PubMed1987

The lateral microsurgical approach to the "extracanalicular" lumbar disc herniation. I: A technical note.

The main aim in the surgery of the canalicular and extracanalicular lumbar disc herniation is to remove safely the hidden fragment without complete destruction of the normal facet joint, without damage to the nerve root and with minimal compromise of the stability of the spinal column. This report describes a lateral approach for operations of extracanalicular lumbar disc herniations in which full visual control allows a decompression of the respective spinal nerve or ganglion and removal of the herniated disc. With this approach, there is minimal resection of bone and facet joint and minimal risk of injury to neural structures. If necessary, this approach can easily be combined with the classical interlaminar exposure.

Humans↗
PubMed1987

The coronal suture, a useful bony landmark in neurosurgery? Craniocerebral topography between bony landmarks on the skull and the brain.

In the present study the variation of the localisation and the course of the coronal suture (CS) was examined on the lateral skull X-ray. The study shows a variation of the localisation and course of the CS from the average position within +/- 4 mm in 65-77% and extreme differences between minimum and maximum values between 16 and 21 mm. The CS has also a considerable variation in its localisation relative to the precentral gyrus. Additionally the craniocerebral relationships and the localisation of the precentral gyrus and pyramidal tract are altered by the lesion or the space occupying process itself. A more exact localisation of the precentral gyrus, respectively the pyramidal tract can be obtained with CT and intraoperative cortical stimulation of the motor strip.

Brain↗
PubMed1986

[Acute spinal epidural abscess].

An acute spinal epidural abscess is a rare cause of paraplegia, seen in seven patients over a period of ten years. All patients had fever and severe localized back-pain. Unless treated, within hours or a few days, there will be root defects and rapidly progressive paraplegia. Staphylococcus is the most frequent causative organism and clinically manifest septicaemia is common. Rapid diagnosis and treatment are essential in deciding the patient's fate. Myelography is an important additional examination as it demonstrates the abscess in 96% of cases. Non-contrast radiology is of little value. High-dosage antibiotics and surgical spinal decompression are the cardinal treatment procedures. Antibiotics alone are justified only so long as there are no neurological deficits and neurosurgical intervention, if needed, is immediately available.

Abscess↗