Acta neurochirurgica
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Acta neurochirurgica · Jan 1994
Historical ArticleGain and loss of the ability to compete. Some aspects of German neurosurgery up to 1939.
Sketchy biographies of 4 German neurosurgeons (Krause, Foerster, Stieda, Tönnis) demonstrate how neurosurgery in Germany rapidly developed and flourished from the end of the 19th century to the middle of the thirties. However, the dictatorship of Hitler, racial persecution, and the Second World War disturbed this promising development markedly and the aftermath was prolonged. It took many years to restore disrupted international relations and to regain the ability to compete in the scientific field.
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Acta neurochirurgica · Jan 1994
Venous and paradoxical air embolism in the sitting position. A prospective study with transoesophageal echocardiography.
This prospective study investigates the frequency of patent foramen ovale (PFO), venous air embolism (VAE) and paradoxical air embolism (PAE) by transoesophageal echocardiography (TOE) in neurosurgical patients operated on in the sitting position. The risk of PAE after exclusion of PFO is assessed. A PFO was identified by pre-operative TOE and VAE and PAE by continuous intraoperative TOE. ⋯ If a PFO is detected, the sitting position should be avoided. A residual risk for PAE remains despite exclusion of PFO because the reliability of TOE is limited. TOE is the method of choice for detecting VAE and PAE.
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Acta neurochirurgica · Jan 1994
Subdural and depth electrodes in the presurgical evaluation of epilepsy.
From 1987 to 1992, invasive EEG studies using subdural strips, grids or depth electrodes were performed in a total of 160 patients with medically intractable epilepsy, in whom scalp EEG was insufficient to localize the epileptogenic focus. Dependent on the individual requirements, these different electrode types were used alone or in combination. Multiple strip electrodes with 4 to 16 contacts were implanted in 157 cases through burrholes, grids with up to 64 contacts in 15 cases via boneflaps, and intrahippocampal depth electrodes in 36 cases using stereotactic procedures. ⋯ We did not encounter any permanent morbidity or mortality in our series. In our experience, EEG-monitoring with chronically implanted electrodes is a feasible technique which contributes essentially to the exact localization of the epileptogenic focus, since it allows nearly artefact-free recording of the ictal and interictal activity. Moreover, grid electrodes can be used for extra-operative functional topographic mapping of eloquent brain areas.
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Acta neurochirurgica · Jan 1994
Intraoperative transcranial electrical motor evoked potential monitoring during spinal surgery under intravenous ketamine or etomidate anaesthesia.
Motor evoked potentials (MEPs), monitoring the motor function directly, are superior to somatosensory evoked potentials (SSEPs) in monitoring the motor system during spinal surgery. Reliable MEPs are difficult to elicit under normal anaesthesia. Using intravenous anaesthesia with either ketamine or etomidate infusion, we performed intraoperative MEP monitoring in 12 spinal operations for 11 cases from February 1992 to May 1992. ⋯ In 2 of which unilateral transient change was noted. Loss of SSEPs was noted in one despite unchanged MEPs, in whom only new sensory deficits occurred postoperatively. Compared to the baseline MEPs in terms of latency and amplitude, the final MEPs improved in 5 sessions, did not change significantly in 4 sessions, deteriorated in one session, and were correlated well with the immediate postoperative motor status.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta neurochirurgica · Jan 1994
Laser Doppler flowmetry of focal ischaemia and reperfusion in deep brain structures in rats.
Monitoring cerebral blood flow during focal ischaemia and reperfusion with established techniques such as hydrogen clearance and autoradiography is difficult. Laser Doppler flowmetry is a new technique, it allows one to continuously measure blood flow in small tissue samples. The objective of this study was to compare laser Doppler flowmetry with hydrogen clearance using a new single fiber probe to obtain measurements in deep brain structures and then to show the temporal profile of cerebral blood flow during focal ischaemia and after reperfusion. ⋯ A rapid decrease in laser Doppler flowmetry to 42 +/- 16% of former baseline values was seen with occlusion of the middle cerebral artery; during occlusion cerebral blood flow remained at this level. Reperfusion resulted in a heterogeneous pattern of cerebral blood flow as laser Doppler flowmetry values ranged from 25% to 134% of baseline values. The effects of middle cerebral artery occlusion and reperfusion on cerebral blood flow can be monitored on-line with laser Doppler flowmetry.(ABSTRACT TRUNCATED AT 250 WORDS)