Zentralblatt für Neurochirurgie
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Zentralbl. Neurochir. · Jan 2000
Comparative Study[Clinical experience with various shunt systems in normal pressure hydrocephalus].
In patients with normal pressure hydrocephalus in the late stage conventional differential valves have the disadvantage that they open abruptly while changing the body position to the vertical line and that they can therefore induce a suction on the ventricles of the atrophic brain. Can these disadvantages and overdrainage complications be minimized by hydrostatic valves? In 117 patients diagnosed for normal pressure hydrocephalus we have implanted 47 Cordis Standard Valves (CSV), 20 Cordis Orbis Sigma Valves Type I (OSV) and 50 Miethke Dual Switch Valves (DSV). 95 patients (36/19/40) could be re-evaluated by means of a control examination. Normal pressure hydrocephalus was graduated according to the results of the intrathecal infusion test in an early and late stage. ⋯ The course of the disease in patients with normal pressure hydrocephalus is influenced by the stage of the disease--degree of cerebral atrophy--and also by the implanted valve type. The high amount of overdrainage complications and subdural hematomas in the Cordis Orbis Sigma Valve Type I group is an argument against its use. Our clinical experiences with the Miethke Dual Switch Valve show that this hydrostatic valve is of advantage for patients with a normal pressure hydrocephalus.
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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.
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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.
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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.