Zentralblatt für Neurochirurgie
-
Zentralbl. Neurochir. · Jan 2000
Case ReportsEnlargement of a chronic aseptic lumbar epidural abscess by intraspinal injections--a rare cause of progressive paraparesis.
The frequent use of invasive procedures at the spinal cord such as epidural injections has led to an increased incidence of iatrogenic abscesses. We report the case of a patient who suffered from low back pain. During epidural lumbar injections of steroids the patient developed severe radicular symptoms, resulting in severe paraparesis. ⋯ The authors prove that the cause of the neurological deterioration was due to epidural injections into a preexisting lumbar chronic aseptic epidural abscess. Harmful and unpleasant complications may occur following epidural injections. Though we present a very rare cause of such complications, a careful monitoring of the neurological status of the patient is necessary as well as the early application of MR imaging in the case of deterioration.
-
Zentralbl. Neurochir. · Jan 2000
Comparative Study[Value of transcranial doppler ultrasonography compared with scintigraphic techniques and EEG in brain death].
Since 1991 transcranial doppler sonography has been accepted in Germany as a technical confirmatory test for the assessment of a cerebral circulatory arrest in patients fulfilling the clinical criteria of brain death. This study correlated transcranial doppler findings to established scintigraphic methods such as planar scintigraphy, 99mTc-HMPAO SPECT and EEG patterns. 21 patients (15 males/6 females, mean age 15-69 yrs.) fulfilled all clinical criteria of brain death. They suffered from head injuries and spontaneous bleedings. ⋯ In the presence of open skull fractures, external liquor drainages and osteoclastic craniotomies oscillating flow in TCD does not constantly represent a cerebral circulatory arrest. Awaiting of systolic spikes is absolutely necessary, if no radionuclide method is available. Determination of brain death by TCD should be carried out by an experienced investigator since unexpected collateral flow signals can be misinterpreted.
-
Zentralbl. Neurochir. · Jan 2000
[Neuro-navigation in the central area: impact on different surgical steps related to the location and various pathological processes].
The neurosurgical treatment of space occupying processes in the central area bears a relatively high risk of either postoperative neurological deficits ("radical approach") or of residual tumor ("conservative approach"). Therefore, special techniques of intraoperative topographic orientation (image-guided surgery) play an important role here. The possible impact of neuronavigation on different neurosurgical steps (craniotomy, corticotomy, localization of the process, definition of borders of resection) was studied in relation to the site of pathology (extraaxial, intraaxial/superficial, intraaxial/deep) in 46 patients harbouring space occupying lesions of the central area. ⋯ It could be shown, that in cases of deep seated processes, neuronavigation had the greatest impact on craniotomy, corticotomy and localization of the process, whereas the borders of resection were defined predominantly on the basis of differences in colour or consistency. In extraaxial pathologies, neuronavigation was of significance only for craniotomy; in intraaxial processes visible at the surface, it had an impact on craniotomy and--in a few cases--on definition of resection borders. In neurosurgery of intraaxial pathologies of the central area (particularly those not visible at the surface), the use of neuronavigation (or another method of intraoperative localization) in combination with neurophysiologic monitoring is strongly recommended.
-
Zentralbl. Neurochir. · Jan 2000
[Practice of perioperative thromboembolic prophylaxis in neurosurgery: results of a German survey].
Many neurosurgical patients are at high risk of developing thromboembolic disease. Although recent data support the benefit of pharmacological thromboembolic prophylaxis, the optimal starting point for the different neurosurgical procedures remains unclear because the potentially devastating consequences of intracranial or intraspinal haemorrhage could easily offset the reduction in thromboembolic morbidity and mortality resulting from pharmacological thromboembolic prophylaxis. The objective of our study was to assess the use of pharmacological methods of thromboembolic prophylaxis in contemporary German neurosurgery using a postal survey in 34 neurosurgical departments. ⋯ Data for burr hole craniotomy or spinal surgery were similar. In our survey a high rate of perioperative use of pharmacological thromboembolic prophylaxis was found. However, given the data from the literature, the optimum protocol remains unclear.