Neurosurgical review
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The treatment of the cerebral glioma continues to challenge neurosurgeons and basic scientists. The lack of major success with chemotherapy and radiation therapy has spurred further investigation into the biology of this tumor and host reactions to it. ⋯ In this review we will discuss the immunobiology of the glioma with specific reference to the interactions between the tumor and the host immune system. In addition, ideas for potential therapeutic manipulation of the host-glioma immune interactions will be reviewed stressing potential pitfalls and risks.
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Landmarks and measurements for the transnasal approach (apertura piriformis, distance to the apertura sinus sphenoidalis) in children and adults are given. Included is the anatomy of the nasal septum, its vessels and nerves. The ostium of the sphenoid sinus, its development, types and dimensions are described. ⋯ For the intracranial approaches the arterial circle and its branches are important for neurosurgeons. The location, number, width and course of these branches are described. Distances and the most important vessels, which are seen by frontal, frontolateral and pterional approaches, are described.
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Modern bipolar electrocoagulation has certain limitations, especially regarding the regulation of the short coagulation course. Studies on the electrical parameters of tissues during heating led to the conclusion that impedance changes in a typical and reproducible way. Furthermore, the impedance value proved to be close to minimal at the moment of coagulation. ⋯ This equipment was tested clinically and the trials showed that the method is practical and most reliable. The microcomputer also allows automatic start of the coagulation as needed during opening or closing of wounds, as well as providing a built-in test of the equipment. This equipment saves time and labour and increases safety.
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Stenosis of the vertebral canal is a form of compressive stenosis in contrast to transport stenosis of vessels or other channels. The concept, definition and pathomorphological properties are discussed. As it is a form of compressive stenosis, the diagnosis is based on measurements of diameters rather than of cross-sectional surfaces. ⋯ The theory is advanced that other determinants may be related to changes in the caudal nerve roots due to either constitutional properties or to subclinical changes induced by ageing and chronic wear and tear, and compression and traction in the area of stenosis during various bodily activities. Suppression of sciatica during I. Cl. is a phenomenon which is particularly difficult to explain.