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This paper is a shortened version of an invited lecture given at the Karolinska Institute, Stockholm, on 17th September, 1993, illustrated with 120 slides.
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... tovább »
Long lasting intracranial hypertension is considered to be a major pathogenic factor of syringomyelia in patients with a Chiari malformation or posterior fossa tumor.
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... tovább »
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.
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... tovább »
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.
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... tovább »
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.
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... tovább »
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.
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... tovább »
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.
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... tovább »
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... tovább »
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.
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... tovább »
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.
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.
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... tovább »
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... tovább »
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... tovább »
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... tovább »
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... tovább »
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... tovább »
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... tovább »
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.
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... tovább »
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.
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... tovább »
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... tovább »
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.... tovább »
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.
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... tovább »
[The aim of this summary is to review some of the therapeutic considerations made at the 11th International Symposium on Parkinson's Disease (Rome).]
[Ernő Jendrassik the neuroscientist. New developments in the classification of dementia syndromes. New observations in multisystem atrophy.]
[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.]
[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.]
[The 1994 and 1995 scientific programme of the Hungarian Spine Association.]
Clinical NeuroscienceCases of inborn errors of metabolism diagnosed in children with autism
Clinical NeuroscienceEvaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations
Clinical NeuroscienceElectrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study
Lege Artis Medicinae[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]
Lege Artis Medicinae[Dear Reader! Greetings to the 30th anniversary of founding the LAM]