Management results attained by predominantly late surgery for intracranial aneurysms.

In contrast to previous studies conducted by various authors, who recommended early surgery for all patients admitted to the hospital within 72 hours of an aneurysmal subarachnoid hemorrhage, several more recent studies have declined to advise early surgery for the treatment of patients with impaired consciousness. In our series, early surgery was undertaken for patients who were rated at Grades 1 to 2 (Hunt and Hess) at admission and who did not exhibit any additional risk factors (e.g., evidence of incipient vasospasm, giant aneurysm, unfavorable aneurysm location, or a severe concomitant disease). Only three patients rated Grade 3 at admission with a favorable aneurysm location and shape underwent early surgery. The management results attained in this series (n = 131), in which the early surgery rate was 17%, have been analyzed. The management mortality rate of patients with aneurysmal subarachnoid hemorrhage was 13%, and it was 7.7% for patients admitted at Grades 1 to 3 on the Hunt and Hess scale. Good results (Glasgow Outcome Scale, 1 or 2) were attained in 75% of the entire study population, in 85% of patients admitted at Grades 1 to 3, and in 53% of those patients who were admitted at Grades 4 to 5 and who underwent late surgery after their condition had improved to Grades 1 to 3. At an average interval of 3 years after the operation, 83% of the patients discharged with Glasgow Outcome Scale ratings of 1 or 2 reported no significant restriction of their "stress resistance."(ABSTRACT TRUNCATED AT 250 WORDS)

[Determination of skull volume (author's transl)]. / Untersuchungen zur Schädelvolumenbestimmung

Various means for indirect skull volume determination were investigated. For this purpose--the procedure of direct measurement of skull volume was improved first, using a latex method. The examinations were carried out on 20 macerated skulls, which were x-rayed in the usual manner and stereoscopically also. Various distances and planes were then determined from the radiographs and varied calculations carried out. From these calculations it appears that skull volume can be simply determined most accurately from the product of transverse diameter (greatest width) and the area of median plane.

[The longitudinal increase of the internal jugular vein and the upper v. cava as measured between the mastoid to the heart: parameter for timing the re-operation after ventriculocardiostomy (author's transl)]. / Das Längenwachstum der Vena jugularis interna und der Vena cava superior vom Processus mastoideus zum Herzen. Ein Parameter für den Zeitpunkt notwendiger Revisionen nach Ventrikulokardiostomien

Some time after ventriculo-cardiostomy in children with hydrocephalus the cardiac catheter is retracting out of the right atrium into the upper veins due to the increase of body length during growth. This might endanger proper functioning of the valve. Therefore most authors are in favour of a prophylactic elongation of the catheter by re-operation. In order to roughly predict the time for re-operation we measured course of the catheter in 4120 children. As a basis for long time supervision of children with this shunt operation we thus propose a curve of length increase of the blood vessels concerned, based on our data, in connection with the known curve of length increase of the body.

[Spontaneous intracerebral hematomas. New aspects since the introduction of computer tomography]. / Spontane intrazerebrale Hämatome Neue Gesichtspunkte seit Einführung der Computertomographie.

Computed tomography has extended the diagnostic possibilities in intracerebral haemorrhages in a decisive manner. Owing to the more exact computer-tomographical diagnosis, especially with regard to the extension and localisation of the haemorrhage as well as the experience gained with simultaneous cerebral pressure measurement, surgical treatment of the haemorrhage can in most cases be carried out through a drilled hole in local anaesthesia. The prognosis of intracerebral haemorrhages is by no means unfavourable from the first, in case of haemorrhages of an unknown etiology in young adults it is even very good. That is why the operation should be carried out in good time. But even patients in a bad condition and cases with additional massive intraventricular bleeding are as such no contraindications.

[Dural tension and skull growth (author's transl)]. / Duraspannung und Schädelwachstum.

By means of animal experiments on rabbits the significance of dural tension in relation to skull growth is emphasised. Our findings support our "new points of view on the pathology and therapy of craniosynostosis", previously published in this journal.

Clinical results of the foraminotomy as described by Frykholm for the treatment of lateral cervical disc herniation.

During the period between 1980 and 1989, foraminotomy as described by Frykholm was performed on 230 patients suffering from lateral cervical disc herniation with exclusively radicular symptomatology. Following an average postoperative period of 3.5 years, the subjective alleviation of symptoms and the neurological symptomatology were examined in 161 patients. The mortality was nil; the morbidity was 5%, with a rapid full recovery in 4% of cases. In addition to the intra-operative findings of soft and hard disc lesions, a third group with combined findings was created. Excellent or good results were obtained in 98% of the patients with soft disc lesions, in 91% of the patients with combined findings, and in 84% of those with hard disc lesions. In 93% of the cases, there was a complete or marked improvement of paresis; in 82%, of the sensory deficits. A total of 92% of the patients were able to carry out their previous occupation to the full extent. The high efficacy of foraminotomy and the low incidence of complications described in previous studies was thereby confirmed.