Early aneurysm surgery and preventive therapy with intravenously administered nimodipine: a multicenter, double-blind, dose-comparison study.

A European, multicenter, prospective, randomized, double-blind, dose-comparison study on preventive therapy with intravenously administered nimodipine was performed to evaluate the efficacy and tolerability of two different doses: 2 and 3 mg/h. Two hundred four patients fulfilled the criteria for enrollment in the study: surgery within 72 hours after the last subarachnoid hemorrhage, and age between 16 and 72 years. All patients who had Hunt and Hess grades of I to III were operated upon; patients who had poor Hunt and Hess grades (IV-V) were operated on according to the surgeon's choice. This treatment regimen was associated with a low incidence of delayed neurological dysfunction with no significant difference between the two dosage groups: three patients (1.5%) remained severely disabled and two (1%) moderately disabled due to vasospasm with or without additional complications. Among the patients with Hunt and Hess grades of IV or V, the long-term outcome was favorable (good-fair) for 40% and unfavorable for 60%. Among the patients with grades of I to III, the long-term outcome was favorable for 89% and unfavorable for 11%.

Reinnervation after microsurgical repair of transected cauda equina fibres. An electromyographic study.

Ventral nerve roots of the lumbar area in seven pigs were transected intradurally and resutured microsurgically immediately after transection. Four to seven months after repair electromyography was done via intradural electric stimulation of the resutured roots. Reinnervation was found. Patterns were compared with data from intact animals.

Tuberous sclerosis in neurosurgery. An analysis of 18 patients.

Eighteen patients with tuberous sclerosis have been analysed, treated between 1981 and 1987. The diagnosis was made on the clinical triad of adenoma sebaceum, mental retardation and epilepsy. In 6 patients a positive family history of the heredo-familial autosomal-dominant disease was found. The neuroradiological examinations showed in 4 patients tumours with obstruction of the ventricles. All 4 patients were operated on and in 2 additional cases only shunt procedures were performed. The diagnosis, neuroradiological investigations with CT scan and MRI, and the neurosurgical management will be discussed in the light of our material and by literature.

Reinnervation of the urinary bladder after microsurgical reconstruction of transsected caudal fibres. An experimental study in pigs.

Reinnervation of the urinary bladder after transsection of cauda equina fibres and their microsurgical reconstruction was studied. In five pigs a partial reconstruction with end-to-end suture of the transsected roots was performed inside the dura mater spinalis; four of these, which had a denervated bladder after the transsection, reestablished the micturition reflex 6 months after the reconstructive operation. The results demonstrate that the reestablished micturition reflex was due to a functional regeneration of transsected and sutured motor fibres. Although a regeneration was proved in sensory as well as in motor neurons by morphologic methods, it is doubtful whether the regenerated sensory fibres took part in the reestablishment of the micturition reflex after contact with the spinal cord.

Metastasis of lung carcinoma to intracranial meningioma. Case report and review of literature.

A metastasis from an adenocarcinoma of the lung into a meningotheliomatous and angiomatous meningioma of the falx is described. The meningioma was extirpated six months after pneumonectomy. Literature review of all such rare occurrences is presented in the discussion.

Diastematomyelia combined with disc herniation at T 6/7 in an adult. Case report.

A case of thoracic diastematomyelia associated with acute disc herniation is reported. The female patient noted sensory and motor symptoms at 49 years of age, four months before hospitalization. Myelography, myelo-computerized tomography and nuclear resonance tomography of the thoracic spine and cord showed the region of diastematomyelia with an additional disc herniation at T 6/7. The bone spur and the disc was successfully excised. Post-operatively, the patient's deficits improved.

Acute subdural hematoma with and without multiple injuries.

A series of 109 patients with clotted subdural hematomas operated on within 72 hours of closed head injuries was evaluated retrospectively. Twenty-seven patients with multiple injuries showed a mortality rate of 77%, those without 59%.

[Initial experiences with implantable pump systems for intrathecal therapy of chronic pain conditions]. / Erste Erfahrungen mit implantierbaren Pumpsystemen zur intrathekalen Therapie chronischer Schmerzzustände.

The therapeutic concept of local administration of opioids into the perimedullar and cerebrospinal fluid is the result of fundamental studies concerning the discovery and localization of specific binding sites. These studies provoked considerable clinical interest, because they suggested a non-destructive and fully reversible method. In our department we have been gathering experience with an implantable pump system for various indications of chronic pain on a sample of 25 patients. The first implantation was performed in February 1987 and the latest included in this study in February 1991. The sample of patients consisted of two groups: (A) Chronic non-malignant pain (13 cases), (B) Chronic pain due to cancer (12 cases). We used two different pump devices: the gas-filled continuous infusion pump (Infusaid, Mod. 400) in 10 cases and the manually tractable micro pump (Cordis) in 15 cases. In 23 cases we decided in favour of an intraventricular drug administration, mainly because of the site of the pain; in each of these a ventricular catheter was placed in the frontal horn of the lateral ventricle. In the remaining two cases, the catheter was placed intraspinally, the catheter tip terminating at thoracic segments. Nine of the patients with cancer-related pain experienced from excellent to acceptable pain relief, as did also 10 patients with chronic non-malignant pain. Side effects were rare. Our findings also indicate that, in carefully selected patients, both malignant and non-malignant pain may be managed satisfactorily with this technique.

Intracerebral granular cell tumor.

A case of a primary intracerebral granular cell tumor (GCT) in a 71-year-old woman is reported. The computed tomographic scan showed a contrast-enhancing, noncalcified mass in the left parieto-occipital region. The tumor was operated upon and the histological findings showed a granular cell tumor with mitotic activity. After radiation therapy the patient recovered well. The origin of intracerebrally growing GCT's remains unclear. Involvement of astrocytes is discussed. Primary GCT's of the cerebrum are potentially more malignant than those of the pituitary region.

[Solitary intracranial late metastasis of a granulosa cell tumor of the ovary. Case report and review of the literature]. / Solitäre intrakranielle Spätmetastase eines Granulosazelltumors des Ovar. Fallbericht und Literaturübersicht.

A 75-year old patient was admitted to hospital in June 1989. She was suffering from headache since three months. In the neurological examination a mild hemiparesis on the left side, personal changes and apractic disturbances could be found. 10 years before a granulosa-cell tumour of the left ovary was extirpated, postoperatively the patient received radiation and polychemotherapy. CT-scan and MRI of the head showed a tumour parieto-occipital on the right hemisphere with multiple cystic and solid areas. The tumour was extirpated in toto. The postoperative course was uneventful. Primary tumour of the left ovary and intracranial metastasis showed the same histological findings.

Long-term neuropsychological outcome after severe head injury with good recovery.

The quality of outcome after severe closed head injury has become of increasing concern to neurosurgeons. The assessment of residual deficits in patients who have recovered from closed head injury can be very difficult. Many patients are classified as having a good recovery according to the Glasgow Outcome Scale (GOS), but this may be insufficiently focused or sensitive to demonstrate mental deficits objectively. We investigated 33 patients with severe closed head injury who subsequently were diagnosed as having made a good recovery according to the GOS. The severity of the injury was determined by the Glasgow Coma Scale (GCS) and by the presence of a midline shift in the preoperative CT scans. There was a minimal interval of 15 months (means = 1080.5 days, SD = 491 days) between injury and time of neuropsychological testing. Their performance was compared with that of 15 orthopaedic cases. Residual neuropsychological deficits can be demonstrated on the majority of measures in a group of patients who have achieved good recovery on the GOS. Midline shift in preoperative CT scans is not of prognostic value for long-lasting neuropsychological deficits.