Preoperative stereotactic localization of cerebral tumors: a new tool to improve microsurgical tumor removal.
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Biomedical subjects
Publications and source records attributed to U Steude.
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In a retrospective study of 303 patients with renal cell carcinomas the prognostic influence of the percutaneous transvasal embolization of the renal artery was demonstrated. In form of the life-table-method we compared statistically the survival rates of preoperatively or palliatively embolized patients with such ones who were only nephrectomized or treated only symptomatically. In the tumour stages T2 and T3 the preoperative percutaneous transvasal embolization leads to a clearly higher survival rate; in stage T2 statistically significant. After palliative embolization the improvement of the prognosis is evident compared with the inoperable patients who were treated only symptomatically. The prognosis after palliative preoperative percutaneous transvasal embolization and retarded nephrectomy is not worse than after preoperative percutaneous transvasal embolization and immediate nephrectomy. The effect of the preoperative and palliative embolization improving the prognosis should incite all partners who up to now objected to this therapeutic method to reconsider their therapy concept.
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owing to an enormous development in the operative technical possibilities, percutaneous surgical methods are available today for both destructive and functional pain interventions, so that the surgical risk can be reduced to a minimum and also patients in a poor general condition and of advanced age can tolerate these interventions at any time.
In 53 external patients with extensive malignant renal tumours before nephrectomy the renal artery was closed centrally by radioopaque ivalonchips. 46 arteries were completely obturated, in 7 cases the embolization was incomplete. This method of embolization is indicated preoperatively because there are some advantages concerning technique of operation. In or ivalon-material there was only one complication without clinical symptoms. The occurring ischemic pain was controllable by medicaments and eased off within some hours. Directly after transcatheter occlusion the patients can be transported back under first aid conditions in hospital where will be nephrectomy carried out.
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In eleven patients with atypical trigeminal neuralgia, following herpes infections or radiation therapy of cancer of the epipharynx, percutaneous electrical stimulation of the trigeminal tract or in the vicinity of the nucleus area was performed. Relief of pain lasting from fourteen days up to six weeks could be obtained.
In the last 13 years, since the introduction of percutaneous chordotomy by Mullan et al. (1963),the method has been developed and has now a solid place in the neurosurgical management of pain problems. The lateral approach of the C1/C2 level with X-ray check, visualization of the spinal cord by means of positive contrast myelography, impedance measurement, and stimulation is the mostly used and the least complicated method. Percutaneous chordotomy should be mainly used in the management of intolerable pain in patients with malignancy. The results of 130 percutaneous chordotomies in 100 patients during the last 2 years are discussed.
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