Zentralblatt für Neurochirurgie
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Zentralbl. Neurochir. · Jan 2003
ReviewGerman Society of Neurosurgery Section on Vascular Neurosurgery: Position Statement on the International Subarachnoid Hemorrhage Trial (ISAT).
The outcome after a specific treatment (clipping or coiling) of ruptured intracranial aneurysms is determined by both the periprocedural complication rate and the success of preventing re-bleeding from the treated aneurysm. The latter is associated with a cumulative risk over many years, particularly in incompletely treated aneurysms. Incomplete occlusion of the aneurysm is not infrequently seen after endovascular coiling, even in cases with a perfect anatomical configuration. ⋯ This good-grade patient population (94 % were WFNS grade 1-3 and 89 % were WFNS grade 1-2) had an almost 10 % higher rate of poor outcome compared to other good-grade patients in large prospective surgical studies or the same outcome as trials that included up to 20 % poor-grade patients.[nl]Neurosurgeons should acknowledge that endovascular coiling is a safe method associated with less complications than clipping in experienced hands (Fig. ). Endovascular radiologists should acknowledge that the success of complete obliteration is higher after surgery, that incompletely occluded aneurysms have a higher rate of re-rupture and that the definitive long-term re-rupture rate still remains unknown. Therefore, we await with interest the angiographic and clinical follow-up data that will provide evidence about the final patient outcome.
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Zentralbl. Neurochir. · Jan 2003
Comparative StudyComparison of the Claassen and Fisher CT classification scale to predict ischemia after aneurysmatic SAH?
Delayed cerebral ischemia (DCI) is an important cause of morbidity and mortality after aneurysmatic subarachnoid hemorrhage (SAH). The severity of SAH, reflected by the amount of blood in the initial CCT, is a well-established predictor of DCI and infarction. The Fisher CT scale is widely used to predict DCI, but recent studies criticised the scale due to the fact that this scale does not differentiate between intracerebral blood clots and intraventricular hemorrhage. Thus Claasen et al. recently proposed a new grading scale to predict DCI. The aim of this study was to compare clinical scales with the CT findings and to verify this newly developed scale in a different population in order to predict DCI.[nl] ⋯ The newly proposed Claassen CT scale provides no additional information and seems not to be superior compared to the well-established Fisher scale to predict DCI.
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The goal of this study was to evaluate the therapeutic role of decompressive craniectomy in severe brain injury. ⋯ A slight, but non-significant benefit could be demonstrated after decompressive craniectomy in the whole patient population. In young patients decompression seems to have a more positive influence on outcome and survival.
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Zentralbl. Neurochir. · Jan 2003
Frameless stereotactic brain biopsy procedures using the Stealth Station: indications, accuracy and results.
This study presents the results of 57 stereotactic brain biopsies using a frameless neuronavigation system, the Stealth Station. The supratentorial lesions had a mean diameter of 33 mm and a mean distance of 32 mm from the entry point at brain surface. In all cases the stereotactic procedure was planned in the preoperative 3-D magnetic resonance data set. ⋯ The mean operation time was 92 minutes including examination of frozen sections. The results of our series demonstrate, that frameless stereotactic systems can also be reliably applied for biopsy of supratentorial lesions larger than 15 mm. Frameless stereotaxy in combination with intraoperative pathological confirmation is a safe and reliable method for stereotactic brain biopsy with a diagnostic yield comparable to frame-based stereotaxy.
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Zentralbl. Neurochir. · Jan 2003
Comparative Study[Shunt operation versus endoscopic ventriculostomy in normal pressure hydrocephalus: diagnostics and outcome].
In contrast to shunt operation the indication for an endoscopic ventriculostomy in patients diagnosed for normal pressure hydrocephalus is not scientifically established. From September 1997 to October 2001 we operated on 79 patients diagnosed for normal pressure hydrocephalus. Diagnosis was established by means of the intrathecal lumbal or ventricular infusion test, the cerebrospinal fluid tap test and MRI-CSF flow studies pre- and post-operatively. ⋯ In that patients we performed a change of the implanted valve with a lower pressure level or rather an implantation of a valve system in the two cases who underwent a ventriculostomy. In patients with a pathologically increased resistance to CSF outflow in the lumbal infusion test a shunt implantation with the Miethke Dual-Switch valve is indicated. Patients whose outflow resistance is increased in the ventricular infusion test are suspected for a functional interventricular stenosis and should be treated by means of an endoscopic assisted ventriculostomy.