Acta neurochirurgica
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Acta neurochirurgica · Sep 2013
Biography Historical ArticleVon Bergmann, Kocher, and Krönlein--a triumvirate of pioneers with a common neurosurgical concept.
The rise of a neurosurgical subspecialisation in general surgery was strongly influenced by some key surgeons. In the German-speaking regions of Europe, Ernst von Bergmann, Emil Theodor Kocher and Rudolf Ulrich Krönlein have to be especially highlighted. ⋯ This triumvirate developed a common neurosurgical concept that was grounded in the physiological experiments and scientific evidence.
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Acta neurochirurgica · Sep 2013
Case ReportsUnusual peroneal nerve palsy caused by intraneural ganglion cyst: pathological mechanism and appropriate treatment.
The origin of the peroneal intraneural ganglion and the outcome of treatment are still controversial. We report here three cases with peroneal intraneural ganglion and discuss the appropriate treatment. In our cases, 58-, 62-, and 65-year-old patients were operated on with extraneural decompression and epineurotomy within 4 months after onset of drop foot. ⋯ We propose correct early diagnosis, simple exoneural dissection, and atraumatic epineurotomy for the successful treatment of peroneal intraneural ganglion. Disruption of the stalk in the articular branch is a key point to prevent recurrence. For early diagnosis, clinicians should be aware of the existence of this rare lesion.
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Acta neurochirurgica · Sep 2013
Pathophysiology of shunt dysfunction in shunt treated hydrocephalus.
We hypothesized that shunt dysfunction in the ventricular catheter and the shunt valve is caused by different cellular responses. We also hypothesized that the cellular responses depend on different pathophysiological mechanisms. ⋯ The same cellular responses (i.e., glial cells and inflammatory cells) cause both catheter obstruction and valve obstruction. We propose two synergistic pathophysiological mechanisms. (1) Ventricle wall/parenchymal contact by the catheter causes mechanical irritation of the parenchyma including ependymal exfoliation. (2) The shunt material provokes an inflammatory reaction, either nonspecific or specific. In combination, these mechanisms cause obstructive tissue ingrowth (glial and inflammatory) in the catheter and clogging of the valve by exfoliated glial cells and reactive inflammatory cells.