[Atypical termination of the vertebral artery and of the inferior posterior cerebellar artery (author's transl)]. / Eine atypische Bildung des Endabschnittes der Arteria vertebralis und der Arteriae cerebellares inferiores posteriores

A rare varient in the termination of the vertebral artery is described associated with a low origin of an unpaired inferior posterior cerebellar artery lying between C. 1 and C. 2. This is illustrated radiographically. An attempt is made to explain this radiologically and to classify it. Possible clinical significant of this anomaly, particularly in relation to subarachnoid haemorrhage, is discussed.

[Computer tomographic ventriculography (author's transl)]. / Computertomographische Ventrikulographie.

A method for elucidating complex abnormalities of CSF circulation by using a positive contrast medium (metrizamide) and computer tomography is described. The technique for the method, the results and their clinical significance is demonstrated. The value of this method is compared with traditional ventriculography and with computer tomography without the use of contrast medium. It is shown that the technique represents an important extension of the scope of computer tomography.

[The clinical and radiological picture of degenerative disease of the extra- and intra-cranial vessels (author's transl)]. / Klinisches und radiologisches Bild der degenerativen Erkrankungen der extra- und intrakraniellen supraaortischen Gefässe.

The clinical and angiograms of 500 patients with degenerative disease of their cerebral vessels were evaluated. The clinical severity of the ischaemic changes was graded and compared with localisation and extent of the angiographic abnormality. In these patients there is an increased risk during angiography and a careful technique has to be employed. Two examples are used to show that it is possible to clarify even complex neurological and angiographic problems by means of an appropriate technique, 90% of our patients with a definite cerebral infarct gave a history of previous transitory ischaemic attacks. In our opinion patients with these attacks are of particular interest to the angiographer and the surgeon.

[The diagnostic value of kymography in aortic isthmus stenosis (author's transl)]. / Der diagnostische Wert der Flächenkymographie bei der Aortenisthmusstenose.

The value of kymography was studied in 133 patients in whom a coarctation had been demonstrated angiographically, operatively or pathologically; its value was compared with conventional radiographic examinations. The difference in pulsation between the pib notching, dilatation of the ascending aorta and increased size of the left ventricle on plain films make it possible to diagnose an haemodynamically significant coarctation without any invasive methods. In 124 haemodynamically significant coarctations (93%), the kymogram showed increased pulsation of the dilated left subclavian artery. In nine haemodynamically insignificant or mild coarctations (7%), this sign was absent. Since the radiographic signs are to some extent reversible, it is possible to evaluate the results of surgery by plain chest films and the kymogram.

[Liquorrhoea and acute meningitis. Complications of a cerebrospinal fluid fistula secondary to a skull fracture suffered 45 years previously]. / Liquorrhée et méningite aiguë. Complications d'une fistule de liquide céphalorachidien consécutive à une fracture du dràne survenue 45 ans auparavant.

A case is described in which liquorrhoea and meningitis occur as complications of cerebrospinal fluid fistula. The patient incurred the initial skull fracture 45 1/2 years prior to that. Three hypotheses as to the long interval are discussed. The authors propose to look for a cerebrospinal fluid fistula after every important trauma of the skull.

[Unusual course of traumatic intracranial bleedings (author's transl)]. / Ungewöhnliche Verlaufsformen traumatischer intrakranieller Blutungen

Intracranial bleedings occurred in three patients as complications of h-ad trauma, without any initial acute disturbance of consciousness. Only careful observation, which revealed slow deterioration in consciousness, made it possible to establish the diagnosis of intracranial haemorrhage, confirmed angiographically in all three instances.

[Complications of the operative neurosurgical treatment of trigeminal neuralgia]. / Komplikationen der operativen neurochirurgischen Behandlung der Trigeminusneuralgie

The complications after neurosurgical treatment of trigeminal neuralgia of 161 patients treated in the neurosurgical hospital university medical school Bonn from 1971 to 1974 are referred. Emphasis is layed on severe complications. After rhizotomia (Dandys method) 3 patients died, one of them because of a meningitis, one of them because of damage of the superior petrosal vein and one after ligature of an irregular auditive artery. One patient died after electrocoagulation of the ganglion Gasseri (Kirschner's method) after having had an important bleeding during coagulation. Another patient developed hemiparesis after a strong arterial bleeding during electrocoagulation. The damage of importance arterial vessels seems to be decisive. Three proposals in order to diminish the risk of the operations are settled: 1. Preoperative neuroradiological checks by means of contrast. 2. Carefully sparing of vessels, especially when precedent scars had alterated the field of operation, perhaps if necessary by means of the operation mikroscope. 3. Control of the lokalisation of the needle during electrocoagulation by X-rays.

[Cervical spine injuries and compression of the vertebral artery (author's transl)]. / Traumen der Halswirbelsäule und Kompression der Vertebralarterien.

Six patients were angiographically examined. A compression of the cerebral artery was verified angiographically only in one patient with a severe dislocation of the cervical spine. Only severe trauma to the cervical spine seems to involve the vertebral arteries. The history of this patient with a verified compression of the vertebral artery is described. It is characterised by primary discrete neurological symptoms gradually getting worse. The cause and resulting consequences are discussed.

[Technique and value of discography for the cervical syndrome (author's transl)]. / Technik und Aussagekraft der Diskographie bei der Diagnostik zervikaler Syndrome

Discography produces relatively many false pasitive findings. Their number, about 28% in our material, may be reduced decisively to below 10% when clinical, electro-physiologic and myelographic findings are considered together. It can be further reduced when results are judged in groups of varying value. Findings of high value are: 1) entry of the contrast fluid from the disc behind the posterior longitudinal ligament. 2) Exact reproduction of spontaneous pain during injection 3) The extension of a contrast band along the roots on the side and level of clinical findings. With such strict evaluation discographic findings are correct in 88%. In additon discography may be in certain cases the only method to elucidate a syndrome which clinically and in the myelogram permits various interpretations. Discography should always preceded operation. On the basis of 368 discographies with control of the diagnosis at operation its value is explained.

[Computed tomography in hypophyseal abscess]. / Computertomographie beim Hypophysenabszess.

This is a report on a rare case of a recurring abscess in the pituitary gland. Diagnosis was extremely difficult to establish preoperatively. This is demonstrated via various radiological methods. Anamnesis and clinical disease pattern are important assisting factors in diagnosis.

Multiple meningiomas. Two patients with a spinal and an intracranial meningioma. Radiological diagnosis.

We report two patients with a spinal and intracranial meningioma without evidence of von Recklinghausen's disease. The radiological and scintigraphical findings are demonstrated. Certain implications with regard to the examination and follow-up of patients with a meningioma are indicated.

[Neurologic complications in hereditary multiple exostoses]. / Neurologische Komplikationen bei hereditären multiple Exostosen.

Based on the radiological and clinical findings in two patients suffering from hereditary multiple cartilaginous exostoses, the importance of identification and x-ray confirmation of neurological signs within the framework of the overall disease patterns is shown. This is a rare complication, bat it is highly important for the patient. Early clarification is imperative; if surgical intervention is not instituted directly, a closely meshed control network is considered mandatory to prevent severe irreversible neurological deficits.

Subdural effusions: determination of contrast medium influx from CSF to the fluid accumulation by computed tomography as an aid to the indications for management.

In 46 patients with subdural effusions CSF dynamics and especially the influx of contrast medium from CSF to the subdural fluid accumulation was investigated by serial computed tomography (CT). In 16 cases the subdural effusion was of traumatic and in 30 cases of non-traumatic origin. The results allowed a subdivision of the patients into three groups. Group 1: patients without contrast medium influx into the subdural fluid accumulation; group 2: patients with delayed influx; group 3: patients with immediate influx. In group 1 patients the subdural effusion acted as a space-occupying process with absolute indication for surgical treatment. Also in group 2 patients the further course showed that a surgical indication was given, because the fluid accumulation did not resolve under conservative management but increased in size, and/or the neurological deficit worsened. In all group 3 patients the subdural effusions decreased and finally disappeared conservatively. Group 1 patients with effusions on traumatic origin generally had more severe injuries than the patients of the other groups. The investigations caused no serious complications. This diagnostic method proved to be a reliable means for early differentiation between the possibility of conservative management or the indication for operative treatment in cases with subdural effusions of different origin.

[Diagnosis of hypophyseal abscess using MRI and high resolution CT]. / Die Diagnostik des Hypophysenabszesses mittels MRI und hochauflösender CT.

Preoperative diagnosis of pituitary abscess is very difficult. In particular, differentiation from other cystic processes of the sellar region is delicate. The clinical and radiological findings of a case of pituitary abscess are presented. Since CT and MRI are of major importance for routine pituitary screening, the aspects of these methods are emphasized. In our experience, both methods can contribute to preoperative diagnosis.