Zentralblatt für Neurochirurgie
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Zentralbl. Neurochir. · Nov 2004
Case ReportsPrognostic value of improved intraoperative motor evoked potentials. A case report.
This unusual case involves intraoperative registration of improved motor evoked potentials accompanied by postoperative improvement of the motor status. ⋯ This intraoperative electrophysiological observation correlated with the postoperative neurological status, thus documenting functional recovery of the motor system through the intervention.
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Zentralbl. Neurochir. · Jan 2004
Case ReportsThe prognostic value of somatosensory evoked potentials in traumatic primary and secondary brain stem lesions.
To estimate the prognostic value of somatosensory evoked potentials elicited via stimulation of the median nerve (M-SSEP) in cases of primary and secondary brainstem lesions 126 patients with traumatic brainstem lesions (GCS < or = 6) were investigated on admission to our hospital. Various parameters of the patients' M-SSEP were compared with the corresponding data of 40 healthy persons. Latency and amplitude of the cervical (N14) and cortical (N20) derived potentials and the central conduction time (CCT) were taken into account. ⋯ Irrespective of a primary or secondary traumatic brainstem lesion, marked changes of N20 represented an unfavourable clinical prognosis. A loss of N20 was closely correlated with a very poor outcome (GOS 1-2) if the N20 potential had not recovered within 48 hours. The recovery of this potential, however, was not necessarily correlated to a recovery of the brain function.
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Zentralbl. Neurochir. · Jan 2004
Characterization of hemorrhagic complications after surgery for temporal lobe epilepsy.
To assess the significance of symptomatic hemorrhagic complications occurring after different temporal resections for temporal lobe epilepsy (TLE) and to compare this data to findings with postoperative hematomas after temporal surgery for mostly glial or metastatic tumors. ⋯ Although associated with a low permanent morbidity, features of postoperative hemorrhages after TLE surgery are characteristically different to complications after surgery for other indications, which has to be kept in mind for patient counseling and obtaining informed consent.
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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
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.