Clinical Neuroscience

[Anatomical basis of endoscopic ventriculostomy - clinical application of the free hand technique]

RESISCH Róbert1, PATONAY Lajos2, JULOW Jenő3

MAY 20, 1997

Clinical Neuroscience - 1997;50(05-06)

[The anatomical basis of the "free hand” technique in treatment of occlusive internal hydrocephalus, viz. endoscopic ventriculostomy, is discussed. In 25 cadavers the cella media of the lateral ventricle was endoscopically approached through a frontoparietal (15 cases), frontal (5) and biportal coronal (5) burr hole. Using the identified structure of the choroid plexus the foramen of Monro was investigated. Via this route, the endoscope advanced into the 3rd ventricle, then the localization of ventricular perforation was determined by first visualizing the mamillary bodies and the infundibular recess. Ventricular anatomy was also investigated in 50 fixed human brains. Between October and December 1995 endoscopic ventricular fenestration using a frontoparietal burr hole was performed on 3 patients without stereotactic localization. In one case the serious condition of the patient, in the other two cases the enormous supratentorial hydrocephalus required the application of the free hand technique. ]


  1. Semmelweis Orvostudományi Egyetem Anatómiai Intézet
  2. Szent Rókus Kórház, Arc- és Állcsontsebészeti Osztály
  3. Szent János Kórház, Idegsebészeti Osztály, Budapest



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Clinical Neuroscience

[Effects of Propofol and Thiopental on median nerve somatosensory evoked potentials and cerebral blood velocity]

MÉSZÁROS István, KASÓ Gábor, BÜKI András, HUDVÁGNER Sándor, PFUND Zoltán, DÓCZI Tamás, NAGY Ferenc

[Effects of induction doses of thiopental and propofol on median nerve somatosensory evoked potentials and cerebral blood flow velocity were investigated in 50 patients suffering from degenerative lumbar spine diseases before operation and during anaesthesia. The propofol influences the cerebral electric activity and the blood flow velocity to a less extend than thiopental. Based on our results we prefer to employ propofol during neurosurgical procedures when using intraoperativ somatosensory evoked potentials and/or transcranial Doppler monitoring. ]

Clinical Neuroscience

[Three dimensional time of flight magnetic resonance imaging in trigeminal neuralgia]


[The purpose of our study was to evaluate the role of three dimensional time of flight magnetic resonance angiography in detection of neurovascular compression in patients with trigeminal neuralgia. 53 patients (26 males, 27 females mean age 57 years) with trigeminal neuralgia underwent 3D TOF MRA. Examinations were performed on 0.5 T Elscint Gyrex V Dlx equipment. The imaging parameters were 33-38/9/25 TR/TE/flip angle with 30-50 mm slab thickness and 1-1.5 mm slice thickness. Contrast material was administered in every case. Maximum intensity projection and thin slice reconstruction (pixel by pixel) were performed in three standard directions (axial, coronal and sagittal). To evaluate the presence or absence of vascular contact, we used both the source slices and reconstructed pictures. Vascular contact with the trigeminal nerve in the entry zone was identified on the symptomatic side in 26 cases (superior cerebellar artery in 20, superior cerebellar artery and vein in one, anterior inferior cerebellar artery in 2, basilar artery or a vein in 1-1 case) and on the asymptomatic side in 3 cases (superior cerebellar arteries). No contact was detected in 24 patients. The examination was not of diagnostic value in three cases, because of head motion artefacts. Veins were better visualized on the contrast pictures. Microvascular decompression sec. Janetta was performed in 9 cases. The surgical and neuroradiological findings were identical in every case. Complete pain relief or significant diminshing of the symptoms were achieved following surgery in all patients. 3D TOF MRA is a useful method in demonstration of vascular contact with the trigeminal nerve at the entry zone, which is valuable information in planning surgical treatment for patients with trigeminal neuralgia.]

Clinical Neuroscience

[Uremic polyneuropathy - clinical and electrophysiological analysis]

PFUND Zoltán, CZOPF József, NAGY Ferenc

[Uremic polyneuropathy is a consequence of chronic renal failure, and is one of the symptoms of the uremic syndrome. Its etiology is not well known, several neurotoxins are presumed as pathogenic factors. Both axonal lesions and demyelinization are involved in the development of neuropathy 66 electrophysiological studies (EMG, ENG) in 57 uremic patients were performed in our department between 1978 and 1988. The correlation between clinical and electrophysiological findings are discussed. Clinical or neurographic and myographic signs of neuropathy were found in 50/57 of the patients. The number of electrophysiological signs changes parallely with the severity of uremic neuropathy. There was significant correlation between the decreased plasma calcium levels, the elevated plasma phosphate levels, and the severity of neuropathy. The electrophysiological symptoms are more frequent in cases of rapidly progressive neuropathy. Peripheral nerve pathophysiology reveals a combination of segmental demyelinization and axonal degeneration.]

Clinical Neuroscience

[Mental disorders after stroke (treatment of post-stroke depression with moclobemide)]

VARGA Dániel, PÉK Márta, NAGY Zoltán

[Post-stroke states are usually characterized by residual neurologic symptoms and movement performance, while psychological disturbances remain hidden. Stroke patients frequently present mood disturbances, cognitive decline, anxiety disorders, sometimes serious schizophorm and paranoid states. Among them, post-stroke depression is the most common and possibly amenable form to therapeutic intervention. Depression has negative effect on rehabilitation, quality of life and even long term survival. Biological, psychological and social factors play an important role in the etiology of post stroke depression. The psychotherapeutic approach is so far undeveloped; considering drug therapy, in the past decade tricyclic drugs have been replaced by newly developed second generation antidepressants with lower side-effects profile. In our experience 6-week treatment with moclobemide in 33 patients resulted in symptom reduction in 80%. Appropriate therapy extends the possibilities of rehabilitation, improves the quality of life, and reduces mortality.]

Clinical Neuroscience

[The genetic diagnosis of leber's hereditary optic neuropathy]

HORVÁTH Rita, ERIC A. Shoubridge, KATHERINE Fu, SOMLAI Judit, HAJDA Márta, KARCAGI Veronika, KOMOLY Sámuel

[We observed the occurence of Leber's hereditary optic neuropathy associated mitochondrial point mutations in patients with bilateral optic neuropathy. DNA samples isolated from peripheral venous blood by the phenol/chloroform method were tested with the help of PCR for the pathogenic Leber's hereditary optic neuropathy associated mitochondrial point mutations. From 14 patients suffering from bilateral visual impairment Leber's hereditary optic neuropathy associated mitochondrial point mutations were found in 5 cases. The patients were previously treated with optic neuritis or with toxic optic neuropathy. By testing the relatives of the patients some asymp tomatic Leber positive cases were observed, too. The diagnosis of Leber's hereditary optic neuropathy is based on the occurence of mitochondrial point mutations. To test for these mutations can help in the clinical practice in diagnosing bilateral optic neuropathies. In patients with the pathogenic Leber mutations the development of the clinical symptoms does not occure necessarily, however the other mechanisms determining the clinical picture are not known so far.]

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[Biportal neuroendoscopy of the prepontine cisterns]


[Introduction - While bi- or multiportal approaches have been adopted in different fields of surgery including abdominal and spine surgery, the uniportal access into the skull is a traditional principle in neurosurgery. In this preclinical cadaver study the authors developed combinations of biportal endoneurosurgical dissections in the prepontine subarachnoid space to test the safety of this technique. Methods - In 34 fresh post-mortem adult human cadavers and 14 formaldehyde-fixed adult human head specimen a total of 48 biportal endoscopical dissections were carried out. 0°, 30°, and 70° lens scopes with a diameter of 1.7 and 4.2 mm and trochars with a diameter of 5.0 to 6.5 mm were used. Results - Six different endoscopic routes to the prepontine region and a total of 10 different combinations of this approaches could be described. Useful and safe biportal combinations were: 1. supraorbital on both sides, 2. supraorbital combined with ipsilateral anterior subtemporal, 3. supraorbital combined with contralateral anterior subtemporal, 4. supraorbital combined with ipsilateral posterior subtemporal, 5. supraorbital combined with ipsilateral frontal interhemispheric, 6. supraorbital combined with contralateral frontal interhemispheric, 7. anterior subtemporal combined with ipsilateral frontal interhemispheric, 8. anterior subtemporal combined with contralateral frontal interhemispheric. Conclusion - The biportal endomicrosurgical strategy offered effective and safe dissections within the prepontine subarachnoid space.]

Clinical Neuroscience

[Endo-sonographic anatomy of the ventricular system]


[A preclinical cadaver study was performed to test a transendoscopic sonographic probe for neurosurgery. In 25 fresh post-mortem adult human cadaver with a total of 39 endo-sonographic dissections in the ventricular system were carried out. A sonograph with an outer diameter of 6 F was used and radial sonograms were made by a realtime image technique. First results showed precise imaging, comparable to a CT in a neighbouring area of 3 cm. In this publication, the authors describe the endo-neurosonographic anatomy of the ventricular system. The sonographic probe was advanced through the working canal of a ventriculoscope, then the endoscopic and sonographic imaging were compared. Results were documented by paralell sonographic and endoscopic photo and video recordings. Based on the authors experience, it is revealed that the additional sonographic view could also be used as a navigation tool.]

Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.