Optic radiations: a microsurgical anatomical study

OBJECT: In this study, the authors used a fiber-dissection technique to describe the optic radiation. They focused on the morphological characteristics (length and breadth) of this structure, its course, and its relationships with neighboring fasciculi and the lateral ventricle. METHODS: The authors dissected 10 previously frozen, formalin-fixed human brains with the aid of an operating microscope by following the fiber dissection technique described by Klingler in 1960. Lateral, inferior, and medial approaches were made. The optic radiation, also known as the Gratiolet radiation, extended from the lateral geniculate body to the calcarine fissure. The average distance from the tip of the anterior Meyer loop to the calcarine sulcus was 105 mm (range 95-114 mm). The breadth of the optic radiations, one on each side of the brain, averaged 17 mm at the level of the inferior horn (range 15-18 mm). This tract could be divided into three main segments: the anterior or Meyer loop, the body, and the end of the optic radiation. Adjacent anatomical structures included: laterally, the inferior longitudinal fasciculi; medially, the tapetum of the corpus callosum; and the ependyma of the inferior horn of the lateral ventricle. CONCLUSIONS: Various practical surgical approaches are discussed. The knowledge gained by studying this particular anatomy will help prevent injury to the optic radiations during neurosurgery.     

Luxation des Ellenbogengelenks des Erwachsenen

Dislocations and fracture-dislocations of the elbow joint result in typical injury patterns of variable joint instability. A systematic and early in-depth analysis of the injury components offers the approach to the options of therapy and the evaluation of the risk potential of the individual lesion. Standardized diagnostic algorithms help to avoid an inadequate assessment of the extent of injury. With regard to the choice of therapy finding a balance between the concentric reduction of the elbow joint, stability and an early regain of motion provides the key to a good functional outcome. A great number of simple elbow dislocations have a good prognosis and can be managed with early motion due to the inherent joint stability after closed reduction. In contrast, the more rare osteo-ligamentous combination injuries have a poor prognosis if the corresponding injury components are not adequately recognized and addressed by a mostly technically demanding surgical treatment to avoid the otherwise impending typical complications. A standardized surgical algorithm may provide the basis to achieve a satisfactory functional result in this challenging clinical entity of elbow trauma.     

MRI assessment of the anatomy of optic radiations after temporal lobe epilepsy surgery

OBJECTIVE: The aim of this study was to determine the course of the temporal optic radiations. MATERIAL AND METHODS: Eighteen patients were included in this prospective study. All of them underwent a temporal lobectomy for epilepsy, including the mesial temporal structures and a variable extent of lateral neocortex (from 2 to 7 cm behind the temporal tip). An MRI was performed 2 months postoperatively, allowing assessment of the extent of lateral resection. Postoperative visual fields were determined by automatic static perimetry (ASP). RESULTS: (1) No patient complained of a disabling visual field deficit. (2) ASP, a highly sensitive technique, however, detected postoperative visual field deficits in 83% of patients, confined to the superior homonymous field contralateral to the resection. (3) A strong correlation was found between the presence of a visual field deficit and the extent of laterotemporal resection. (4) The smallest anteroposterior resection resulting in a field defect was limited to 20 mm from the temporal tip. CONCLUSION: (1) This study confirms a strong correlation between postoperative visual field deficits and the extent of lateral neocortical temporal resection. (2) The anterior limit of Meyer's loop is likely to be located more rostrally than previously believed. (3) Despite this, lateral resection remains useful in some cases for seizure control.     

Zur Kenntnis des Plattenepithelcarcinoms des Nierenbeckens

Ohne Zusammenfassung Mit 5 Abbildungen     

Verletzungen des Nierenbeckens und des Ureters

About 5% of injuries of the urinary tract affect the renal pelvis and ureter and constitute a severe complication. Around 75% of these injuries are iatrogenic and only about 25% are caused by blunt abdominal trauma or perforation. To avoid complications and improve prognosis, immediate diagnosis and therapy are essential. The diagnostic accuracy of preoperative studies is low, therefore frequently injuries are detected during explorative laparotomy. The management of upper urinary tract lesions depends on severity and localization, whereas the ultimate ambition should always be the preservation of the kidney. As a basic rule, ureteral stenting is mostly sufficient for small lesions, and only larger injuries require open reconstructive techniques. Longitudinal studies document a high degree of functional reconstitution if adequate and immediate treatment is carried out.