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Clinical Neuroscience - 1994;47(05-06)
Content
Clinical Neuroscience
MAY 20, 1994
Transoral and anterolateral surgery of the cervical spine in ventral extradural pathological processes
This paper is a shortened version of an invited lecture given at the Karolinska Institute, Stockholm, on 17th September, 1993, illustrated with 120 slides.
Clinical Neuroscience
MAY 20, 1994
Correlation of clinical and molecular genetic findings in malignant brain stem tumors
Brain stem gliomas are rare, predominantly pediatric tumours. Histologically, they are comparable to adult supratentorial astrocytomas. Most of the pediatric brain stem tumours were classified as low-grade astrocytoma (WHO II), anaplastic astrocytoma (WHO III) or glioblastoma multiforme (GBM, WHO IV). Survival of patients with malignant brain stem gliomas as WHO grade III and IV rarely exceeds more than two years. Recently developed molecular genetic techniques gave new insights in tumour biology. Oncogenes and tumour suppressor genes are genetic alterations which can cause tumorous transformation and furthermore malignant progression. Molecular genetic studies of malignant brain stem gliomas have rarely been investigated. Therefore, we set out to study 12 such tumours clinically and 2 by molecular biological methods.
Clinical Neuroscience
MAY 20, 1994
Simultaneous occurence of unilateral multiplex meningiomas and syringomyelia
Long lasting intracranial hypertension is considered to be a major pathogenic factor of syringomyelia in patients with a Chiari malformation or posterior fossa tumor.
Clinical Neuroscience
MAY 20, 1994
Different autoregulatory responses in the cerebellar cortex, neocortex and subcortical gray matter of the rat to systemic hypo- and hypertension
Cerebral autoregulation was investigated in the cerebral and cerebellar cortex, and subcortical gray matter (caudate nucleus) of the rat by means of Laser-Doppler flowmetry. As the vascular architecture of the basal ganglia, the cerebral cortex and the cerebellar cortex have substantial geometrical, onto genetical and pathological differences (3), we tested the working hypothesis that autoregulation of the blood supply to these areas may also be different. Laser-Doppler flowmetry has an ideal time resolution, and it enables analysis of flow-pressure curves (1, 2). The dependency of autoregulation on the rate of change in systemic blood pressure (SABP) in all three regions were confirmed. Control of CBF was significantly different in the subcortical gray matter and the neocortex. Interestingly, no autoregulatory capacity of the cerebellar vasculature was found.
Clinical Neuroscience
MAY 20, 1994
Epidermoid tumours of the posterior fossa
In opposite of the benign biological behaviour of the posterior fossa epidermoids the operation of these tumours a great challenge for the surgeon both theoretical and surgical point of view. We analysed our 14 operated cases clinico pathologically in this retrospective study.
Clinical Neuroscience
MAY 20, 1994
Cine brain MR examinations and its value in the analysis of pathology of the posterior fossa
The study of motion of the central nervous system in the one of the most difficult problems in neuroradiology. Visualisation of brain parenchyma motions and cerebrospinal fluid flow is very important in understanding of normal cerebral physiology as well as pathological processes. Magnetic resonance imaging is the most available non-invasive method for investigation these motions taken as a function of heart cycle. In this lecture we would like to presentour resulto in developing sequences and to demonstrate the usefulness of CINE measurements in diagnostic work.
Clinical Neuroscience
MAY 20, 1994
The use of MR angiography in the diagnostics of vascular malformations of the posterior fossa
We have been using MRI and MR angiography (MRA) in the diagnostics of intracranial pathology for two years. We performed MR angiography in about 50% of the examinations. In case of vascular diseases and malformations additional 3D sequences were used which were localised in the volume of interest. As demonstrating a few cases we would like to show the possibilities and usefulness of MRA in the evaluation of posterior fossa vascular malformations.
Clinical Neuroscience
MAY 20, 1994
Benign tectal glioma, deffinition of a new entity
Brain stem gliomas account for 10–25% of intracranial tumours in childhood. It has shown that mid brain tumours localised in the tectal plate frequently have a very benign clinical course. Clinical and radiological signs of benign tectal gliomas are not established neither are these characteristics correlated to histological features. Based on a retrospective analysis of 25 histologically verified tectal plate gliomas we attempted to define the clinical and radiological characteristics of this new entity to help a more appropriate patient managment.
Clinical Neuroscience
MAY 20, 1994
Our experience with stereotactic cerebellar simulation
The role of the cerebellum in organizing of movement and regulation of tonus of skeletal muscles is well known. There were attempts to influence central movement disorders by various neurosurgical interventions. The results were not predictable and so these methods were not generally accepted. Precise stereotactical positioning of electrodes with applications of neurophysiological tests is however promising.
Clinical Neuroscience
MAY 20, 1994
The effect of acute expanding posterior fossa mass on the brain stem auditory evoked potentials on cats
Data exits about the value of intraoperative monitoring of brain stem auditory evoked potentials (BAEP-s) regarding its reliability in early detection of functional brain stem disturbances are presently controversial.The possibility of differentiation between reversible intraoperative disturbances of the brain stem functions and its irreversible damage based on BAEP changes has not yet been established. The investigation of this question was carried out experimentally on 11 cats simulating acute space occupying lesion in the posterior fossa via dilatation of an elastic balloon. During the balloon inflation BAEP-s were continuously recorded. Studying regional changes of the brain glucose metabolism, C14 deoxyglucose autoradiography was performed on each animal. Blood-brain barrier damage was also investigated by Evans blue method.
Clinical Neuroscience
MAY 20, 1994
The fear of the sitting position
The basis of the author's observations is a series of posterior fossa operations done in the sitting position between 1968 and 1992. The main pathological diagnoses were: astrocytoma grade 1/2, 19; ependy- moma 23; haemangioblastoma 30; medulloblastoma 36; metastases 69. Total 187.
Clinical Neuroscience
MAY 20, 1994
Significance of alcohol related coagulation disorder in cases of cerebral contusion in chronic alcoholics
In severe alcoholic liver disease each phase of blood coagulation mechanism is affected leading to abnormal haemostasis (1.). This has a definitive effect on the morphology and progress of cerebral contusional haemorrhages. Under these conditions large confluent intraparenchymal bleeding develops from multiple subcortical foci. The laceration of cerebral tissue and space occupying haemorrhagic lesion aggravate the prognosis of skull trauma. The aim of our study is to show and analyse the contusional haemorrhages in chronic alcoholic patients reporting an illustrative case.
Clinical Neuroscience
MAY 20, 1994
Recurrent posterior fossa haemangioblastomas
We presented reviews of various aspects of posterior fossa haemangioblastomas operated on at the Hungarian National Institute for Neurosurgery and at St. John's Hospital. (2, 3, 4) The present work examines some problems concerning recurrence of these tumours.
Clinical Neuroscience
MAY 20, 1994
The level of growth hormone after the surgical treatment of acromegalic patients
The main goals in the treatment of the acromegalic patients are: to make the blood level of the growth hormone (GH) unmeasurable, to remove tumor completely, to make the somatomedine level in blood normal, to eliminate the recurrence of the disease and to preserve the frontal lobe of the pituitary gland. The aplication of dopamine agonists with long-term effect has become an adjuvant therapy to the surgery and radio-therapy. The Sandostatin, a somatostatin analogue with long-term effect, has occupied a dominant position in the inhibition of growth hormone secretion.
Clinical Neuroscience
MAY 20, 1994
The possibilities of the 3 dimensional MR angiographie (3 D MRA) in the posterior fossa tumors
The 3D MRA is a very good non-invasive investi gation of patients having brain tumors of different types of the diseases of the intracranial vessels. This investigation can not give always enough information about every fine detail of the pathologic processes. Because of this fact in a lot of cases other methods have to be performed (for example DSA). lt is mostly necessary before operations. ln our previous works we have investigated this problem in the cases of supratentorial tumors and vascular malformations. According to our practical experience the characteristics of the vascular malformations are the same in cases of the supra-and infratentorial processes, but on the other hand, they are not the same in cases of tumors. Because of that we have reviewed the MRl results of the posterior fossa tumors. lt has been an important point of view of our work if the MRA methodcould be able to substitute the DSA and generally any kind of information could be expected from this method in these cases.
Clinical Neuroscience
MAY 20, 1994
Calcified cervical intervertebral disc herniation in childhood
The calcified cervical intervertebral disc and its herniation was described by Weens in 1945(5). Its appearance is sporadic and its etiology is unknown. The number of the published cases in the literature are more than 50, but none has been published in Hungary.
Clinical Neuroscience
MAY 20, 1994
Anesthesia for medulla oblongata surgery
Hazards to patients undergoing brainstem operations include venous air embolisation, hypotension, vital sign changes and specific cranial nerve injury. Except for vital sign changes, these hazards are widely discussed in various handbooks and articles. Vital sign changes may result either from massive venous air embolism or bramstem compression caused by surgical manipulation. If the operated area is very close to the vasomotor center, even the most careful manipulation can cause extreme bradycardia with hypotension. These perilous changes frequently keep the surgeon from continuing the operation. Transitional pacemaker therapy can be used during these types of operations to prevent critical cardiac arrests.
Clinical Neuroscience
MAY 20, 1994
Stereotactic radiosurgery as a new modality in the treatment of neurosurgical pathologies in the posterior fossa
Stereotactic Radiosurgery (STRS) is one of the fastest growing fields in neurosurgery. Though it was first introduced by Lars Leksell for functional neurosurgery, over the last two decades a wide range of pathological conditions were treated world-wide. In this paper the experiences of the Sheffield Gamma Unit in the treatment of posterior fossa lesions will be summarized.
Clinical Neuroscience
MAY 20, 1994
Neurinoma of the abducens nerve
Abducens nerve neurinomas are very uncommon. There have been only 5 cases published in the literature up till now. We present another case of abducens nerve neurinoma.
Clinical Neuroscience
MAY 20, 1994
Cavernous angiomas of the brainstem and cerebellum. A study of 16 cases
There are only a few reports dealing with cavernous angiomas of the brain stem and cerebellum. Some authors suggest that a brainstem cavernoma causing repeated bleedings should be removed in case it is close to the pial surface. With adequate surgical technique the removal of these lesions can be performed without significant morbidity or mor tality. In this paper we analyze the clinical data and results of 16 patients with brainstem of cerebellar cavernomas, ten of them were treated surgically.
Clinical Neuroscience
MAY 20, 1994
Effect of ND-YAG laser on brain tissue
The application of new technological innovations into the armamentarium of neurosurgical instruments is spreading in neurosurgical departments all over the world. Laser surgery is one of the newest methods for tissue removal. We have been using a CO2 laser in the National Institute of Neurosurgery for three years. The low grade mobility and flexibility of this equipment is one of the greatest disadvantage, while using it for neurosurgical operations. The availability of a fiberoptic delivery system for the new generation of Nd-YAG lasers is very helpful. ln spite of this, severe complications can be caused by the not correct use of Nd-YAG lasers, like delayed necrosis and subsurface tissue vaporisation. The safe use of Nd-YAG lasers in the brain needs a high level of knowledge and understanding of different aspects of laser-tissue interactions. For this aim, as the first step to introduce this kind of laser into neurosurgical operations, we carried out animal experiments for testing the effect of the Nd YAG laser beam on brain tissue.
Clinical Neuroscience
MAY 20, 1994
Surgery of brain stem tumors
In 1939 Bailey et al. described the treatment of brain stern tumors as a "pessimistic chapter" in the history of neurosurgery. Because of the anatomical location and the tendency to infiltrate along fibre tracts, the early signs and symptoms of brain stem tumor are frequently misleading. This insidious development in the absence of papilla edema makes early diagnosis difficult. Since microneurosurgery was introduced as a routine procedure, it has enabled previously impossible results to be achieved in about all fields of neurosurgery. Lesions which had been regarded as inoperable, could be approached with more optimism than ever before. Such a field in neurosurgery, showing trernendous improvement in recent years, is the surgery of brain stem lesions.
Clinical Neuroscience
MAY 20, 1994
Subgroups of brain stem tumors in childhood
Neuroimaging (MR, CT) and surgical (microsurgery, CUSA, laser) techniques have revolutionised the neurosurgeon's view on tumours within the brain stem and emanated new perspective in their management. With the growing experience, it has nowadays become evident that the wide variety of tumours here and the very different ways they are treated call for a detailed classification of these tumours. Features such as MR and CT appearance, contrast uptake, exact localisation and also the neurological signs they evoke might be the sound basis for creating subgroups in this special cohort of brain tumour patients. Exophitic tumours growing dorsally into the 4th ventricle24 and intrinsic tumours of the cervicomedullary junction' have a favourable prognosis while the diffusely growing hypodens gliomas (high grade in many cases) or exophitic tumours growing laterally do not exhibit follow up longer than 6–15 months.
Clinical Neuroscience
MAY 20, 1994
Vasospasm after removal of intracranial tumors
Scince transcranial Doppler ultrasonography (TCD) has taken place in the assessment of blood flow velocities in the basal arteries (1), the number of cerebral angiographies to demonstrate vasospasm has decreased (2). The vasospasm occur mostly after aneurysmal subarachnoid haemorrhage but in trauma, in meningitis, in hypothalamic laesion could be observed as well as after operations on intracranial tumors (3). In our study we put emphasis on latter since only case reports have only been reported previously.
Clinical Neuroscience
MAY 20, 1994
Complex hydrocephalus
The majority of patients with acute symptomatic hydrocephalus are treated perfectly satisfactorily on the basis of clinical history, a CT scan and a conventional shunt. However, more chronic forms of hydrocephalus in all age groups may be difficult to distinguish from cerebral atrophy of various types on the basis of clinical symptoms/signs and CT scan alone, although Hakim's classical triad of gait disorder, urinary incontinence and dementia (mental dullness and recent memory loss) is very useful. Various forms of CSF tap test (Wikkelso, Hakim, continuous drainage) will reveal the immediate responders but not those who improve with shabunting only after some weeks or even months. Subdural collections remain a considerable threat following conventional shunting. Finally, 80% of shunts fail by 12 years and many patients return with a variety of symptoms attributed to shunt dysfunction which are very difficult to elucidate including headache and cognitive decline. How far have new investigations and shunt tech- niques helped manage these intractable problems that can lead on occasion to disaster?
Clinical Neuroscience
MAY 20, 1994
Thoracodorsal nerve transfer in brachial plexus traction injuries
In the majority of cases of the brachial plexus traction injury the only possibility for nerve repair is a nerve transfer. The prognosis for surgical treatment in cases of upper brachial palsy is somewhat better than in cases of total palsy because of better possibilities for reinnervation using regional intact collateral branches of the brachial plexus as donors. Volpius and Stoffel, in 1920, and Foerster in 1929 used these nerves in repair of the axillary and musculocutaneous nerves. The imperfections of the other methods of nerve transfer led us back to these procedures, especially to the thoracodorsal nerve transfer.
Clinical Neuroscience
MAY 20, 1994
Neuromas of the posterior fossa other than acoustic neuroma
Neuromas of the posterior fossa other than acoustic neuromas are uncommon. In a personal series of over 500 acoustic neuromas, there have been associated 12 patients with facial nerve neuroma 11 cases of trigeminal neuroma, and 14 patients with neuroma of the jugular foramen.
Clinical Neuroscience
MAY 20, 1994
Possibilities of preservation the facial nerve function in acoustic tumor surgery
In acoustic neuroma surgery the preservation of the facial function and hearing became principle concerns since using microsurgical techniques. Anatomical preservation of the facial nerve is not always correlate to it's functional integrity (Table 1.). In the literature numerous possibilities were reported in intraoperative monitorisation of the facial nerve function during acoustic tumor surgery. (1., 2., 3.) In our report we demonstrate our electrophysio logical data of an illustrative case during and after the total resection of grade 4 acoustic neuromas.
Clinical Neuroscience
MAY 20, 1994
Primary squamous cell carcinoma in the cerebellopontine angle
Primary intracranial squamous cell carcinomas are extremely rare and appear to arise from benign epidermoid cysts. We report a case of a car cinoma in the right cerebellopontine angle which proved to be primary at autopsy and review the relevant literature.
Clinical Neuroscience
MAY 20, 1994
Medulloblastoma and non-recurrent supratentorial tumors in two children
Medulloblastoma is a highly malignant tumor of the cerebellum and occurrs predominantly in children. Despite its malignant biological behaviour, agressive treatment of medulloblastoma has helped to improve the survival of patients harboring such lesion. Recently, large series of long-term survivors have been reported. However, any evidence of secondary tumor as local recurrence or as metastasis still indicates a poor prognosis for patients with medulloblastoma. Here, we report two long-term surviving pediatric patients with second non-recurrent tumors. Such lesions become increasingly im portant in the management of long-term survivors.
Clinical Neuroscience
MAY 20, 1994
Surgical experience with trigeminal neuriomas
Trigeminal neurinomas usually arise from the sensory root centrally to the ganglion, occasionally from the Gasserian ganglion itself, or even from its peripheral branches. According to the site of primary growth of the tumor it can be located predominantely in posterior, or in middle cranial fossa. Dumbbell shape tumors located in both cranial fossae usually require combined supra and infratentorial surgical approaches. During the period of the years 1990-1993 we met three patients with trigeminal neurinomas.
Clinical Neuroscience
MAY 20, 1994
Surgery of vertebro-basilar aneurysms re-evaluated
It has long been a common view of the world's neurosurgical community that saccular aneurysms located at the junction of bilateral vertebral arteries where the basilar artery arises from (VB aneurysm) impose extreme diffuculties to their surgical repair. These difficulties have been agreed to be caused by the narrowest working space for dissecting and clipping the aneurysm, while structures around this particular location with their vital functional importance are most sensitive to retraction. The difficulties have been apparently amplified when the aneurysm had recently ruptured because of further limits in mobilizing aneurysm, vessels and attached surfaces. As the experiences of our aneurysm surgery team in the National Institute of Neurosurgery have increased, our attitude toward these lesions used to be called no-man’s-land aneurysms have gained more and more confidence and this is felt as the right time to report our results.
Clinical Neuroscience
MAY 20, 1994
Experiences with the extraforaminal approach in microsurgery of exterme lateral lumbar disc herniations
The extreme lateral lumbar disc herniation is a new entity. We talk about it since the time of widespread application of CT and MRI for the diagnosis of spinal diseases. The old neuroradiological diagnostic methods like myelography could not give any information about it, because these disc protrusions or herniations are out of the intervertebral foramen, that is out of the myelographically detectable part of the intervertebral root.
Clinical Neuroscience
MAY 20, 1994
The "rete mirabile" of the clivus and dorsum sellae
An osteofibrous space at the level of dorsum sellae and the upper two thirds of clivus, wedged between the intracranial periosteum and dura mater facing the basal cisterns, was studied in respect to the branching pattern of the internal carotid. A large number of anastomoses between these branches and their opposite mates and the posterior meningeal branches of the external carotid were also considered. This large anastomotic network was named as ”rete mirable” by Wallace et al”. These vessels are of utmost importance as collateral pathways in case of occlusion of the internal carotid artery below the cavernous sinus as well as in the arterial supply of some intracranial tumors.
Clinical Neuroscience
MAY 20, 1994
[Parkinsonism 1994 Some thoughts from the 11th International Parkinson's Disease Symposium]
[The aim of this summary is to review some of the therapeutic considerations made at the 11th International Symposium on Parkinson's Disease (Rome).]
Clinical Neuroscience
MAY 20, 1994
[At the scientific memorial meeting of the Hungarian Society of Neurologists and Mental Doctors]
[Ernő Jendrassik the neuroscientist. New developments in the classification of dementia syndromes. New observations in multisystem atrophy.]
Clinical Neuroscience
MAY 20, 1994
[Neurology Clinic of SZOTE]
[New data on the pathogenesis of multiple sclerosis. The importance of electrophysiological studies in the diagnosis of multiple sclerosis. Diagnosis and modern therapy of multiple sclerosis. Rehabilitation of patients with multiple sclerosis. Corticosteroid treatment of isolated optic neuritis. Clinical Pathology Conference.]
Clinical Neuroscience
MAY 20, 1994
[Hungarian branch of the International Antiepileptic League]
[In March 1994, the MIEL board and membership held its annual general meeting at the Flamenco Hotel in Budapest. In his secretary's report, Dr. Péter Rajnai assessed the events of the just completed term. The annual Győr epilepsy workshops in the autumn, the tenth in a row last year, served to further educate MIEL members.]
Clinical Neuroscience
MAY 20, 1994
[Hungarian Spine Association]
[The 1994 and 1995 scientific programme of the Hungarian Spine Association.]
1.
Clinical Neuroscience
[Headache registry in Szeged: Experiences regarding to migraine patients]
21. MAY
2.
Clinical Neuroscience
[The new target population of stroke awareness campaign: Kindergarten students ]
21. MAY
3.
Clinical Neuroscience
Is there any difference in mortality rates of atrial fibrillation detected before or after ischemic stroke?
27. NOV
4.
Clinical Neuroscience
Factors influencing the level of stigma in Parkinson’s disease in western Turkey
27. SEP
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Clinical Neuroscience
[The effects of demographic and clinical factors on the severity of poststroke aphasia]
18. JUL
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