Zentralblatt für Neurochirurgie
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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.
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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 2002
Vertebral artery injury after cervical spine trauma: a prospective study.
Vertebral artery (VA) -injury is rarely symptomatic and can therefore easily be overlooked. However, thromboembolic complications may result in permanent morbidity or mortality due to brainstem ischemia and infarction. In this prospective study a standardized protocol for the diagnosis and management of VA-injury following blunt cervical spine trauma with subluxation or fractures affecting the transverse foramen was evaluated. ⋯ The subgroup of patients with dislocation or fracture related stenosis of the transverse foramen should undergo early angiography for establishment of anticoagulation to prevent thromboembolic complications. It appears that the radiological diagnosis of VA-insufficiency is more sensitive than clinical findings, which rarely indicate VA-insufficiency. In this series one VA injury was overlooked with MRA.
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Zentralbl. Neurochir. · Jan 2002
Clinical Trial[The microscopic assisted percutaneous approach to posterior spine - a new minimally invasive procedure for treatment of spinal processes].
The aim of our attempts and trials was to develop a minimally invasive posterior approach to the spine which utilises the smallest access to the target without additional harmful effects on the stability of the spine and at the same time allows excellent dealing with the lesions depending on the advantage of the operative microscope in providing 3 dimensional view of the operative field. In the period between May 1998 and February 2001, 356 patients were treated for different spinal disorders using this approach. The approach was applied in 299 surgeries for lumbar disc herniation and we called the procedure: microscopic assisted percutaneous nucleotomy (MAPN). ⋯ The minimal trauma induced by this approach allows rapid mobilisation of the patients and short hospital stay. A postoperative back orthoses is not necessary. The technique can also be done under local anaesthesia particularly when needed as in old people with severe co-morbidity.