Immediate posttraumatic CSF-fistulas are a well known entity after severe head injury. Delayed on... more Immediate posttraumatic CSF-fistulas are a well known entity after severe head injury. Delayed onset of rhinorrhea is considered to be rare. In the last 5 years 7 patients were treated in our department, who developed rhinorrhea 2-25 years after trauma. All patients went through episodes of meningitis. In 4 cases intermittent rhinorrhea was reported. In all cases a bony defect of the anterior skull base was detected by coronal bone window CT-scan. In three of them an encephalocele was revealed by MR-scanning. Treatment consisted in reconstruction of anterior skull base with a pedicled galeal-pericranial flap via a bifrontal craniotomy and went out without any complications. Delayed rhinorrhea after severe head injury is not a rare curiosity. In cases of bony defects after head injury reconstruction of anterior skull base is recommended to prevent episodes of recurrent meningitis.
Object. The aim of this study was to evaluate the feasibility of monitoring brain tissue oxygenat... more Object. The aim of this study was to evaluate the feasibility of monitoring brain tissue oxygenation (PO2) during aneurysm surgery for the detection of procedure-related ischemia. Methods. Between 1997 and 1998, PO2 was monitored prospectively in a cohort of 40 patients (42 recordings) during aneurysm surgery in the anterior circulation within the vascular territory of the aneurysm-bearing artery. The position of the probe used to measure oxygenation levels was verified on computerized tomography (CT) scanning on the 1st postoperative day. Because of the mislocation of one probe and the malfunction of another, data from only 38 patients (40 recordings) were suitable for analysis. Relative changes from baseline to absolute nadir values of intraoperative PO2 were correlated with simultaneously recorded somatosensory evoked potentials (SSEPs), and cardiovascular and ventilatory parameters. The frequency of ischemic events was evaluated with the aid of CT on the 1st postoperative day as...
BackgroundIntraoperative navigated ultrasonography has reached clinical acceptance, while publish... more BackgroundIntraoperative navigated ultrasonography has reached clinical acceptance, while published data for the accuracy of some systems are missing. We technically quantified and optimised the accuracy of the integration of an external ultrasonography system into a BrainLab navigation system.MethodsA high-end ultrasonography system (Elegra; Siemens, Erlangen, Germany) was linked to a navigation system (Vector Vision; BrainLab, Munich, Germany). In vitro accuracy and precision was calculated from differences between a real world target (high-precision crosshair phantom) and the ultrasonography image of this target in the navigation coordinate system. The influence of the intrinsic component of the calibration phantom (for ultrasonography probe registration), type of target definition (manual versus automatic) and orientation of the ultrasound probe in relation to the navigation tracking device on accuracy and precision were analysed in different settings (100 measurements for each ...
Verletzungen der Frontobasis bergen auch im Kindesalter das Risiko einer sekundaren intrakraniell... more Verletzungen der Frontobasis bergen auch im Kindesalter das Risiko einer sekundaren intrakraniellen Infektion [10–12, 14, 15]. In der References sind die Parameter, die eine operative Revision der Schadelbasis im Kindesalter (und Erwachsenenalter) stutzen, jedoch sehr uneinheitlich beurteilt.
Carpal tunnel syndrome is a compression neuropathy of the median nerve in the carpal tunnel, caus... more Carpal tunnel syndrome is a compression neuropathy of the median nerve in the carpal tunnel, causing pain, numbness and tingling in the hand. Several techniques for operative treatment are available. Carpal tunnel release can be performed using an open, ...
Die fibrose Dysplasie (FD) der Schadelbasis ist eine seltene, lokal expansive, primar benigne Erk... more Die fibrose Dysplasie (FD) der Schadelbasis ist eine seltene, lokal expansive, primar benigne Erkrankung des Knochens und gekennzeichnet durch den Ersatz von Knochen/-mark durch fibro-ossares Gewebe. Sie wird hervorgerufen durch eine nicht hereditare, aktivierende Mutation des GNASl-Gens, die als postzygotische somatische Mutation Zellen aller drei Keimblatter betrifft und so zu einer sehr variablen Phanotypisierung fuhren kann [15]. Als Ausdruck der kongenitalen Erkrankung interessieren in dieser Darstellung die die Schadelbasis betreffenden Manifestationen im Kindesalter.
Journal of Neurological Surgery Part A: Central European Neurosurgery
Background Discharge to rehabilitation is reported in large studies as one important outcome para... more Background Discharge to rehabilitation is reported in large studies as one important outcome parameter based on hospital codes. Because neurologic outcome scores (e.g., the modified Rankin Scale [mRS]) are missing in International Classification of Diseases (ICD) databases, rehabilitation indirectly serves as a kind of surrogate parameter for overall outcome. Reported fractions of patients with rehabilitation, however, largely differ between studies and seem high for patients with aneurysm clipping. Variances in rehabilitation fractions seem to largely differ between treatments (clipping versus coiling) for unruptured intracranial aneurysms, so we analyzed our patients for percentage of and potential factors predicting rehabilitation. Patients From July 2007 to September 2013, 100 consecutive patients with at least one cerebral aneurysm underwent aneurysm clipping. Aneurysms were classified as incidental, associated, pretreated (coil compaction after subarachnoid hemorrhage), and sy...
Journal of Neurological Surgery Part A: Central European Neurosurgery
Background Cortical bone trajectory (CBT) is a relatively new technique for pedicle screw inserti... more Background Cortical bone trajectory (CBT) is a relatively new technique for pedicle screw insertion in the field of spine surgery. Previous studies have demonstrated the significantly better pullout and toggle characteristics the new method offers, and it appears to have certain advantages over the widely used traditional trajectory. The mechanism of the pullout and toggle characteristics still remains unknown. Purpose To report the medium- to long-term follow-up findings of patients who underwent posterior lumbar interbody fusion or posterior lumbar fusion (PLIF/PLF) at our institution and to discuss the ideal screw trajectory when using this technique. Study Design Retrospective radiologic study. Methods Fifty-five patients who underwent PLIF/PLF for lumbar spondylosis using the new technique between January 2011 and January 2016 were included. Clinical outcome was assessed using the Japanese Orthopaedic Association scores for low back pain and visual analog scale scores. Screw lo...
Journal of Neurological Surgery Part B: Skull Base
Objective To analyze the current clinical use of navigation at the lateral skull base among skull... more Objective To analyze the current clinical use of navigation at the lateral skull base among skull base surgeons in Germany. Methods A web-based questionnaire was provided to surgeons being head of the department and member of one of the following scientific societies: German Society of Head and Neck Surgery, Maxillo-Facial Surgery, Neurosurgery, and German Skull Base Society. Replies were recorded anonymously. The questionnaire included the estimated case load per year and percent of surgery performed with navigation (middle and posterior fossa), type of navigation, estimates of intraoperative inaccuracy, and reasons for not using navigation. Results Eighty nine out of 99 replies met requirements for final analysis. Overall, 37% of skull base surgeons use navigation on a regular basis (15% use no navigation). Optical tracking is more frequently used than magnetic tracking (71 vs 19). At the middle fossa, ENT surgeons split into routine users (n = 10/36) and rare users (n = 16/36), t...
Among spinal tumors that occur intradurally, meningiomas, nerve sheath tumors, ependymomas, and a... more Among spinal tumors that occur intradurally, meningiomas, nerve sheath tumors, ependymomas, and astrocytomas are the most common. While a spinal MRI is the state of the art to diagnose intradural spinal tumors, in some cases CT scans, angiography, CSF analyses, and neurophysiological examination can be valuable. The management of these lesions depends not only on the histopathological diagnosis but also on the clinical presentation and the anatomical location, allowing either radical resection as with most extramedullary lesions or less invasive strategies as with intramedullary lesions. Although intramedullary lesions are rare and sometimes difficult to manage, well-planned treatment can achieve excellent outcome without treatment-related deficits. Technical advances in imaging, neuromonitoring, minimally invasive approaches, and radiotherapy have improved the outcome of intradural spinal tumors. However, the outcome in malignant intramedullary tumors remains poor. While surgery is...
Shprintzen-Goldberg syndrome is a rare connective tissue disorder characterized by marfanoid habi... more Shprintzen-Goldberg syndrome is a rare connective tissue disorder characterized by marfanoid habitus and additional dysmorphic stigmata. Craniocervical anomalies occur in fewer than 30% of cases. Serious vertebral instability can also occur, albeit rarely. The authors report on the first patient treated with surgical fusion at the craniocervical junction because of a C-1 dysplasia and severe instability. The skeletal and cardiovascular anomalies that can pose additional problems for surgical treatment and perioperative care are discussed in detail.
Paragangliomas/pheochromocytomas are rare neuroendocrine tumors that arise from the adrenal gland... more Paragangliomas/pheochromocytomas are rare neuroendocrine tumors that arise from the adrenal gland or ganglia at various sites throughout the body. They display a remarkable diversity of driver alterations and are associated with germline mutations in up to 40% of the cases. Comprehensive molecular profiling of abdomino-thoracic paragangliomas revealed four molecularly defined and clinically relevant subtypes. Paragangliomas of the cauda equina region are considered to belong to one of the defined molecular subtypes, but a systematic molecular analysis has not yet been performed. In this study, we analyzed genome-wide DNA methylation profiles of 57 cauda equina paragangliomas and show that these tumors are epigenetically distinct from non-spinal paragangliomas and other tumors. In contrast to paragangliomas of other sites, chromosomal imbalances are widely lacking in cauda equina paragangliomas. Furthermore, RNA and DNA exome sequencing revealed that frequent genetic alterations foun...
Immediate posttraumatic CSF-fistulas are a well known entity after severe head injury. Delayed on... more Immediate posttraumatic CSF-fistulas are a well known entity after severe head injury. Delayed onset of rhinorrhea is considered to be rare. In the last 5 years 7 patients were treated in our department, who developed rhinorrhea 2-25 years after trauma. All patients went through episodes of meningitis. In 4 cases intermittent rhinorrhea was reported. In all cases a bony defect of the anterior skull base was detected by coronal bone window CT-scan. In three of them an encephalocele was revealed by MR-scanning. Treatment consisted in reconstruction of anterior skull base with a pedicled galeal-pericranial flap via a bifrontal craniotomy and went out without any complications. Delayed rhinorrhea after severe head injury is not a rare curiosity. In cases of bony defects after head injury reconstruction of anterior skull base is recommended to prevent episodes of recurrent meningitis.
Object. The aim of this study was to evaluate the feasibility of monitoring brain tissue oxygenat... more Object. The aim of this study was to evaluate the feasibility of monitoring brain tissue oxygenation (PO2) during aneurysm surgery for the detection of procedure-related ischemia. Methods. Between 1997 and 1998, PO2 was monitored prospectively in a cohort of 40 patients (42 recordings) during aneurysm surgery in the anterior circulation within the vascular territory of the aneurysm-bearing artery. The position of the probe used to measure oxygenation levels was verified on computerized tomography (CT) scanning on the 1st postoperative day. Because of the mislocation of one probe and the malfunction of another, data from only 38 patients (40 recordings) were suitable for analysis. Relative changes from baseline to absolute nadir values of intraoperative PO2 were correlated with simultaneously recorded somatosensory evoked potentials (SSEPs), and cardiovascular and ventilatory parameters. The frequency of ischemic events was evaluated with the aid of CT on the 1st postoperative day as...
BackgroundIntraoperative navigated ultrasonography has reached clinical acceptance, while publish... more BackgroundIntraoperative navigated ultrasonography has reached clinical acceptance, while published data for the accuracy of some systems are missing. We technically quantified and optimised the accuracy of the integration of an external ultrasonography system into a BrainLab navigation system.MethodsA high-end ultrasonography system (Elegra; Siemens, Erlangen, Germany) was linked to a navigation system (Vector Vision; BrainLab, Munich, Germany). In vitro accuracy and precision was calculated from differences between a real world target (high-precision crosshair phantom) and the ultrasonography image of this target in the navigation coordinate system. The influence of the intrinsic component of the calibration phantom (for ultrasonography probe registration), type of target definition (manual versus automatic) and orientation of the ultrasound probe in relation to the navigation tracking device on accuracy and precision were analysed in different settings (100 measurements for each ...
Verletzungen der Frontobasis bergen auch im Kindesalter das Risiko einer sekundaren intrakraniell... more Verletzungen der Frontobasis bergen auch im Kindesalter das Risiko einer sekundaren intrakraniellen Infektion [10–12, 14, 15]. In der References sind die Parameter, die eine operative Revision der Schadelbasis im Kindesalter (und Erwachsenenalter) stutzen, jedoch sehr uneinheitlich beurteilt.
Carpal tunnel syndrome is a compression neuropathy of the median nerve in the carpal tunnel, caus... more Carpal tunnel syndrome is a compression neuropathy of the median nerve in the carpal tunnel, causing pain, numbness and tingling in the hand. Several techniques for operative treatment are available. Carpal tunnel release can be performed using an open, ...
Die fibrose Dysplasie (FD) der Schadelbasis ist eine seltene, lokal expansive, primar benigne Erk... more Die fibrose Dysplasie (FD) der Schadelbasis ist eine seltene, lokal expansive, primar benigne Erkrankung des Knochens und gekennzeichnet durch den Ersatz von Knochen/-mark durch fibro-ossares Gewebe. Sie wird hervorgerufen durch eine nicht hereditare, aktivierende Mutation des GNASl-Gens, die als postzygotische somatische Mutation Zellen aller drei Keimblatter betrifft und so zu einer sehr variablen Phanotypisierung fuhren kann [15]. Als Ausdruck der kongenitalen Erkrankung interessieren in dieser Darstellung die die Schadelbasis betreffenden Manifestationen im Kindesalter.
Journal of Neurological Surgery Part A: Central European Neurosurgery
Background Discharge to rehabilitation is reported in large studies as one important outcome para... more Background Discharge to rehabilitation is reported in large studies as one important outcome parameter based on hospital codes. Because neurologic outcome scores (e.g., the modified Rankin Scale [mRS]) are missing in International Classification of Diseases (ICD) databases, rehabilitation indirectly serves as a kind of surrogate parameter for overall outcome. Reported fractions of patients with rehabilitation, however, largely differ between studies and seem high for patients with aneurysm clipping. Variances in rehabilitation fractions seem to largely differ between treatments (clipping versus coiling) for unruptured intracranial aneurysms, so we analyzed our patients for percentage of and potential factors predicting rehabilitation. Patients From July 2007 to September 2013, 100 consecutive patients with at least one cerebral aneurysm underwent aneurysm clipping. Aneurysms were classified as incidental, associated, pretreated (coil compaction after subarachnoid hemorrhage), and sy...
Journal of Neurological Surgery Part A: Central European Neurosurgery
Background Cortical bone trajectory (CBT) is a relatively new technique for pedicle screw inserti... more Background Cortical bone trajectory (CBT) is a relatively new technique for pedicle screw insertion in the field of spine surgery. Previous studies have demonstrated the significantly better pullout and toggle characteristics the new method offers, and it appears to have certain advantages over the widely used traditional trajectory. The mechanism of the pullout and toggle characteristics still remains unknown. Purpose To report the medium- to long-term follow-up findings of patients who underwent posterior lumbar interbody fusion or posterior lumbar fusion (PLIF/PLF) at our institution and to discuss the ideal screw trajectory when using this technique. Study Design Retrospective radiologic study. Methods Fifty-five patients who underwent PLIF/PLF for lumbar spondylosis using the new technique between January 2011 and January 2016 were included. Clinical outcome was assessed using the Japanese Orthopaedic Association scores for low back pain and visual analog scale scores. Screw lo...
Journal of Neurological Surgery Part B: Skull Base
Objective To analyze the current clinical use of navigation at the lateral skull base among skull... more Objective To analyze the current clinical use of navigation at the lateral skull base among skull base surgeons in Germany. Methods A web-based questionnaire was provided to surgeons being head of the department and member of one of the following scientific societies: German Society of Head and Neck Surgery, Maxillo-Facial Surgery, Neurosurgery, and German Skull Base Society. Replies were recorded anonymously. The questionnaire included the estimated case load per year and percent of surgery performed with navigation (middle and posterior fossa), type of navigation, estimates of intraoperative inaccuracy, and reasons for not using navigation. Results Eighty nine out of 99 replies met requirements for final analysis. Overall, 37% of skull base surgeons use navigation on a regular basis (15% use no navigation). Optical tracking is more frequently used than magnetic tracking (71 vs 19). At the middle fossa, ENT surgeons split into routine users (n = 10/36) and rare users (n = 16/36), t...
Among spinal tumors that occur intradurally, meningiomas, nerve sheath tumors, ependymomas, and a... more Among spinal tumors that occur intradurally, meningiomas, nerve sheath tumors, ependymomas, and astrocytomas are the most common. While a spinal MRI is the state of the art to diagnose intradural spinal tumors, in some cases CT scans, angiography, CSF analyses, and neurophysiological examination can be valuable. The management of these lesions depends not only on the histopathological diagnosis but also on the clinical presentation and the anatomical location, allowing either radical resection as with most extramedullary lesions or less invasive strategies as with intramedullary lesions. Although intramedullary lesions are rare and sometimes difficult to manage, well-planned treatment can achieve excellent outcome without treatment-related deficits. Technical advances in imaging, neuromonitoring, minimally invasive approaches, and radiotherapy have improved the outcome of intradural spinal tumors. However, the outcome in malignant intramedullary tumors remains poor. While surgery is...
Shprintzen-Goldberg syndrome is a rare connective tissue disorder characterized by marfanoid habi... more Shprintzen-Goldberg syndrome is a rare connective tissue disorder characterized by marfanoid habitus and additional dysmorphic stigmata. Craniocervical anomalies occur in fewer than 30% of cases. Serious vertebral instability can also occur, albeit rarely. The authors report on the first patient treated with surgical fusion at the craniocervical junction because of a C-1 dysplasia and severe instability. The skeletal and cardiovascular anomalies that can pose additional problems for surgical treatment and perioperative care are discussed in detail.
Paragangliomas/pheochromocytomas are rare neuroendocrine tumors that arise from the adrenal gland... more Paragangliomas/pheochromocytomas are rare neuroendocrine tumors that arise from the adrenal gland or ganglia at various sites throughout the body. They display a remarkable diversity of driver alterations and are associated with germline mutations in up to 40% of the cases. Comprehensive molecular profiling of abdomino-thoracic paragangliomas revealed four molecularly defined and clinically relevant subtypes. Paragangliomas of the cauda equina region are considered to belong to one of the defined molecular subtypes, but a systematic molecular analysis has not yet been performed. In this study, we analyzed genome-wide DNA methylation profiles of 57 cauda equina paragangliomas and show that these tumors are epigenetically distinct from non-spinal paragangliomas and other tumors. In contrast to paragangliomas of other sites, chromosomal imbalances are widely lacking in cauda equina paragangliomas. Furthermore, RNA and DNA exome sequencing revealed that frequent genetic alterations foun...
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