Development and present state of cerebellopontine angle surgery from the neuro- and otosurgical point of view.

fter a short review of the historical development of surgery of cerebellopontine angle tumours, the latest results of neurosurgery are compared with those of otosurgery in this field. The advantages and disadvantages of neurosurgical and otosurgical approaches are discussed.

Natural antibodies to cell-surface antigens of human astrocytoma.

Sera of 200 non-transfused healthy male blood donors were tested for antibody reactivity to cell-surface antigens of cultured astrocytoma cells. Positive reactions were observed only rarely by protein-A assay (PA), in about half the cases by immune adherence assay (IA) and in nearly all cases by anti-C3 mixed hemadsorption assay (C3-MHA). In general, titers were low and only seven sera showed reactivity at 1:1,000. Serum 537 showed the strongest reaction. The anti-astrocytoma reactivity in this serum was due to an IgG antibody. Extensive absorption analysis with a panel of cell lines and fresh cells of both benign and malignant origin, as well al fetal cells, revealed that this serum detected an antigen that was present on most neural-crest-derived tumors (astrocytomas, melanomas and neuroblastomas), on very few other malignant tumors and on fetal brain. The antigen detected by serum 537 shows close relationship to the astrocytoma antigen AJ which had been defined by the serum of a patient with astrocytoma. Both antigens appear to be differentiation antigens present predominantly on non-epithelial neoplasms. The antigen detected by serum 537 is heat-stable and pronase-resistant. The sera of two other healthy donors apparently had a similar specificity, whereas the four other high-titered sera and all other sera detected class-III antigens which were non-specific and not tumor-restricted.

Direct visualization of intracranial tumours in stereotactic and angiographic films by computer calculation of longitudinal CT-sections: a new method for stereotactic localization of tumour outlines.

A new method for the direct transformation not only of a target point, but also of the whole tumour outlines from sagittal, coronal, and oblique computer calculated CT-reconstructions to stereotactic X-ray films of any scale is presented. The role of this method in the stereotactic therapy of intracranial tumours and the possibilities which are thus provided are discussed.

Autologous antibodies to meningioma cell surface antigens.

Sera of 32 patients with meningioma were tested for reactivity to cell surface antigens of autologous meningioma cells with protein-A assay (PA), immune adherence assay (IA), and anti-C 3-mixed hemadsorption assay (C3-MHA). Antibodies against autologous meningioma could be detected in 6/32 patients by PA, in about half the patients by IA and in almost all patients by C3-MHA with titers ranging from 1:2 to 1:28. Only the serum reactivity detected by C3-MHA was high enough for analysis of the specificity of the reaction by absorption tests. By absorption with a panel of autologous, allogeneic and heterologous cells we were unable to demonstrate a meningioma-specific antigen. Most autologous sera detected oncofetal antigens. Serum reactivity to autologous meningioma showed no correlation to antibodies to SV-40.

[Neurosurgical treatment of trigeminal neuralgia]. / Die neurochirurgische Behandlung der Trigeminusneuralgie.

Sweet's method for thermocoagulation of the Gasserian ganglion is a real advance in the operative treatment of trigeminal neuralgia. The advantages of this method are obvious: minimum operation risk, minimum complication rate, short postoperative convalescence, shorter confinement to hospital and finally the possibility of repeating the operation without risk in the event of a relapse.

[Neurosurgical treatment of trigeminal neuralgia (author's transl)]. / 9. Die neurochirurgische Behandlung der Trigeminusneuralgie (Rückshau und Ausblick)

Follow-up studies of 210 cases treated by electrocoagulation and of 146 cases treated by temporal subtotal resection of the posterior root (Frazier) and descriptions of a further 1946 cases in a cooperative study in which different surgical treatments were applied are used as a basis for discussion advantages and disadvantages of the different surgical methods. Selective elimination of pain fibers with protection of tactile sensibility seems the most desirable objective. With this in mind, the new percutaneous method developed by Sweet receives particular attention.

[Oerations on peripheral nerves, plexus and nerve roots, including subarachnoid block with phenol in chronic pain (author's transl)]. / 5. Eingriffe an den peripheren Nerven, Plexus and Nervenwurzeln einschliessich intrathekaler Anwendung von Phenol bei chronischen Schmerzzuständen

Peripheral surgery was performed in 112 patients. Neurolysis or resection of neurons gave rather poor results in pain after nerve injury and stump pain. Rhizotomy is considered to be more effective in those cases. Rhizotomy is also successful in radicular, especially coccygeal, pain syndromes. Subarachnoid blocks with Phenol gave similar promising results. Causalgia responds well in a high percentage of cases to sympathectomy; cases of postherpetic neuralgia phantom pain and tabetic crises generally do not respond to peripheral surgery.

[Problems of peripheral nerve surgery in amputation stump pain and phantom limbs]. / Die Problematik peripherer Eingriffe bei Stumpfund Phantomschmerzen

Follow-up examination of 17 patients with severe and lasting stump and phantom limb pain which could not be improved by analgetics and who then underwent surgical procedures at the neuroma. The results were discouraging. Only 2 patients showed a lasting improvement. Resection of the neuroma and injection of alcohol into the neuroma seem to be successful only if the preoperative history of pain is very short or if there is an isolated injury of a peripheral nerve and a subsequent single neuroma.

[Changes in cerebral blood flow and oxidative cerebral metabolism after extensive acute head trauma (author's transl)]. / Veränderungen der Hirndurchblutung und des oxidativen Hirnstoffwechsels bei akuten substaniellen traumatischen Hirnschäden

Total cerebral blood flow and oxidative cerebral metabolism were measured at normal pCO2, hypocapnia and hypercapnia in 15 unconscious patients in the acute phase after head trauma. In the basal position (normal CO2) measurements were within normal limits and did not correspond to the severity of the clinical picture. But on altering arterial pCO2 there were market changes in oxidative cerebral metabolism, which suggests an abnormal cerebral regulatory mechanism. Measurement of the same functions 14 days later indicated, on the one hand, persistence of changes, but, on the other, a return to normal of previously markedly elevated cerebral glucose uptake. Comparing cerebral blood flow and metabolism between patients who survived and those who died in the acute phase after brain damage, there were no significant differences.

Long-term results of Gasserian ganglion electrocoagulation.

This report is a follow-up study of 315 patients under 46 years old who suffered from trigeminal neuralgia and were treated by electrocoagulation of the Gasserian ganglion. The average foll-up period was 12.7 years, the maximum 33 years. Eighty percent had a return of pain, but 96.7% ultimately attained freedom from pain after repeat electrocoagulation.