Katheterthrombose während intravaskulärem Temperaturmanagement

We report on a case of catheter-related thrombosis after 7?day catheter placement during intravascular temperature management (IVTM), in spite of the use of prophylactic anticoagulants. There were no clinical sequelae. According to the literature, occult thrombosis during ITVM could be more frequent than previously reported and dedicated monitoring for potential thrombosis may be indicated. However, a study comparing IVTM with surface cooling found no differences in clinical outcome. Therefore, n either of the methods can be recommended over the other. Further studies should evaluate the rate of occult thrombosis during the use of both cooling methods.     

Effect of bilateral stimulation of the subthalamic nucleus on different speech subsystems in patients with Parkinson's disease

The effect of deep brain stimulation on the two speech‐production subsystems, articulation and phonation, of nine Parkinsonian patients is examined. Production parameters (stop closure voicing; stop closure, VOT, vowel) in fast syllable‐repetitions were defined and measured and quantitative, objective metrics of vocal fold function were obtained during vowel production. Speech material was recorded for patients (with and without stimulation) and for a reference group of healthy control speakers. With stimulation, precision of the glottal and supraglottal articulation as well as the phonatory function is reduced for some individuals, whereas for other individuals an improvement is observed. Importantly, the improvement or deterioration is determined not only on the basis of the direction of parameter change but also on the individuals' position relative to the healthy control data. This study also notes differences within an individual in the effects of stimulation on the two speech subsystems. These findings qualify the value of global statements about the effect of neurostimulatory operations on Parkinsonian patients. They also underline the importance of careful consideration of individual differences in the effect of deep brain stimulation on different speech subsystems.     

Neuropathologische und neuroradiologische Aspekte akuter disseminierter Enzephalomyelitiden (ADEM)

Among non-neoplastic lesions of the central nervous system, demyelinating pseudotumors of the group of acute disseminated encephalomyelitis (ADEM) most frequently occasion neurosurgical intervention for purposes of definitive diagnosis and thus enter the domain of the surgical pathologist. Typically, ADEM presents with multifocal, bilateral lesions in an asymmetrical distribution. Especially monolocular manifestations may be diagnostically challenging. Due to the acuteness of clinical symptoms and the expansive, space-occupying character of the lesions a diffuse glioma, a metastatic disease, a primary cerebral Non-Hodgkin's lymphoma, brain abscess, a parasitosis or an ischemic brain tissue necrosis may be suspected. This impression is supported by uptake of contrast-medium most pronounced at the periphery of the lesion and the subcortical location. The histomorphologic feature of relative axonal preservation in areas with acute myelin breakdown and lymphocytic infiltrates make the diagnosis of an acute primary demyelinating disease probable. A diagnosis of glioma may be prompted by the florid, cytologically atypical astrogliosis especially in intraoperative request. Based on a series of 14 cases of radiologically and bioptically documented cases of ADEM typical examples will be demonstrated and discussed.     

Thermocoagulation of the dorsal root entry zone for the treatment of intractable pain

The authors report the results of DREZ thermocoagulation in 35 patients since March 1980. This technique was applied not only in patients with deafferentation pain after brachial plexus avulsion, but also for postamputation phantom limb pain and pain caused by injury to the spine and spinal cord, by peripheral nerve lesions, and by multiple sclerosis. Independent of etiology, the duration of the pain syndrome, and the quality and projection of the pain, the overall results have been satisfactory and long-lasting.     

Peroperative transcranial sonography for electrode placement into the targeted subthalamic nucleus of patients with Parkinson disease: technical note

BACKGROUND: In the search for a better preoperative knowledge of the position of probes and electrodes, we assessed the feasibility and the usefulness of transcranial sonography during surgery for the implantation of stimulation electrodes into the subthalamic nucleus (STN) of patients with Parkinson's disease. METHODS: Transcranial sonography was carried out during stereotactic surgery in 8 patients with Parkinson's disease who had a suitable temporal bone window on the side receiving the electrode. Test stimulation parameters were 130 Hz, 0.1 ms, up to 0 to 4.5 V. RESULTS: The test probe with a diameter of 0.8 mm was visualized through the temporal preauricular window. The correct anatomic position of the electrode tip could be indirectly assessed thanks to the topographic relationship of the STN with the hyperechogenic substantia nigra and the nucleus ruber. The tip position of the final electrode was easily documented. A laterality of 10.5 to 11.5 mm, verified by teleradiographic ventriculography and plain films, was correlated with the best response of symptoms of Parkinson's disease to electrical impulses delivered to the STN. CONCLUSIONS: Transcranial sonography is easily feasible during stereotactic surgery. In combination with the clinical effects of electrostimulation on the symptoms of Parkinson's disease and with stereotactic x-ray images, it enables the assessment and the documentation of the correct position of implanted STN electrodes in real time.     

Acidic fibroblast growth factor (aFGF) is present in the fluid of brain tumour pseudocysts

Summary Fluid samples from brain tumour pseudocysts were examined for the presence of Fibroblast Growth Factor (FGF). Fluids were collected from 6 patients with differentiated low grade gliomas (group A), 3 anaplastic gliomas (group B) and 3 metastases (group C). For FGF assays pooled fluids from group A, B, and C were subjected to affinity chromatography on a Heparin-Sepharose column. Each pool contained endothelial cell mitogenic activity which eluted in the 1.2 M NaCl fraction and to a lesser degree in the 0.6 M fraction of Heparin-Sepharose high affinity chromatography. Mitogenic activity in the 1.2 M NaCl fraction of Heparin-Sepharose chromatography suggests the presence of acidic FGF (aFGF).     

Spatial definition of cerebral tumors

The spatial definition of brain tumors can be obtained by CT and angiography carried out under stereotactic conditions. A standard CT software is used to obtain stereotactic coordinates of any intracranial point. Serial stereotactic biopsies provide a precise and detailed histologic diagnosis, including grading and volume estimation. The stereotactic approach is directed at a better understanding of the relationship between the brain and the lesion. It provides a rational basis for the choice among treatment modalities. Our experience so far with a series of 401 cases is reported on.     

Beitrag der Nuklearmedizin zur Diagnostik des Hirntumorrezidivs und der zerebralen Radionekrose

Zusammenfassung Ziel der Studie: Die Beurteilung des Hirntumorrezidivs und der davon differentialdiagnostisch abzugrenzenden posttherapeutisch bedingten benignen Ver?nderungen nach operativer Resektion und/oder Radiatio stellt eine Herausforderung sowohl für die morphologisch orientierten (cCT/MRT) als auch die funktionell bildgebenden Verfahren (SPECT/PET) dar. Anhand einer Literaturübersicht und der hier vorgestellten Daten des eigenen Patientenguts soll die diagnostische Effizienz von L-3-[¹²³I]Iodo-α-methyltyrosin-SPECT (IMT-SPECT) und [¹⁸F]-Fluorodeoxyglucose-PET (FDG-PET) im Rahmen der Rezidivdiagnostik und dem In-vivo Grading prim?rer Hirntumoren aufgezeigt werden. Patienten: 39 Patienten im Alter zwischen 26 und 67 Jahren, bei denen im Rahmen der Nachsorge der Verdacht auf das Vorliegen eines Tumorrezidivs nach vorangegangener operativer Resektion und/oder Radiatio bestand, wurden zur weiteren Abkl?rung einer IMT-SPECT- und FDG-PET Diagnostik zugeführt. Bei 34/39 Patienten lag ein Rezidiv vor, in 12 F?llen ein zus?tzlicher Grading-Wandel. Mit FDG-PET und IMT-SPECT konnten alle Tumoren h?heren Malignit?tsgrads nachgewiesen werden. Im Vergleich zu FDG zeigte IMT eine h?here Sensitivit?t, niedriggradige Rezidive zu best?tigen. FDG-PET ist im Gegensatz zu IMT-SPECT in der Rezidivdiagnostik hinsichtlich des nichtinvasiven Gradings Methode der Wahl. Sowohl die PET als auch die SPECT-Befunde erm?glichten zwischen einem Rezidiv und der Radionekrose zu differenzieren. Bei 2 Patienten führte die nuklearmedizinische Diagnostik zum Nachweis eines Rezidivs, in 1 weiteren Fall wurde eine Radionekrose best?tigt. Diskussion: Zusammenfassend belegen die Ergebnisse insbesondere im Fall unklarer cCT/MRT-Befunde, da? mit der IMT-SPECT in der Rezidivdiagnostik und der FDG-PET bei Verdacht auf einen Grading-Wandel entscheidende diagnostische Zusatzinformationen gewonnen werden.      

Current significance of stereotactic exploration in the diagnosis and therapy of space-occupying cerebral processes

To reach good functional results in patients with spaceoccupying processes--especially with those localized in the dominant hemisphere operative treatment should be planned individually, which is impossible if all diagnostic assessments are followed by the same surgical procedure. The choice of appropriate method of therapy in case of brain tumor depends on various factors, such as the histological nature, extent and volume, relationship to the brain structures and vessels, and spatial form of the growth. The synthesis of all neuroradiological information from stereotactic exploration, together with the histological findings from stereotactic serial biopsies yields a three-dimensional representation of the brain with the tumor. This method seems to offer the optimal basis for the choice of appropriate treatment--especially for gliomas--between surgery, radiotherapy (external or/and interstitial), endocavitary radiation therapy or drainage.