Long-term telemetric intracranial pressure monitoring for diagnosis and therapy optimisation of idiopathic intracranial hypertension.

Background: Idiopathic intracranial hypertension (IIH) is a disease which is difficult to diagnose and moreover difficult to treat. We developed a strategy for long-term telemonitoring of intracranial pressure (ICP), by incorporation of the NEUROVENT®-P-tel System, with the goal of improved diagnosis and consequent therapy of this disease. We highlight the results obtained through this approach.

Real-Time Evaluation of Optic Nerve Sheath Diameter (ONSD) in Awake, Spontaneously Breathing Patients.

(1) Background: Reliable ultrasonographic measurements of optic nerve sheath diameter (ONSD) to detect increased intracerebral pressure (ICP) has not been established in awake patients with continuous invasive ICP monitoring. Therefore, in this study, we included fully awake patients with and without raised ICP and correlated ONSD with continuously measured ICP values. (2) Methods: In a prospective study, intracranial pressure (ICP) was continuously measured in 25 patients with an intraparenchymatic P-tel probe.

Home telemonitoring of intracranial pressure.

Background: As technical progress advances, telemonitoring has become an important part of patient care in many areas of medical treatment. However, distanced surveillance of intracranial pressure (ICP) could not be established so far. With the recent introduction of a telemetric ICP measurement probe, new possibilities arise.

The view through the ventricle catheter - The new ShuntScope for the therapy of pediatric hydrocephalus.

Purpose: Correct placement of the ventricle catheter directly influences the function of cerebral shunt systems. The incidence of proximal catheter misplacement reaches up to 45%. To avoid misplacements and revisions a new intra-catheter endoscope for precise ventricle catheter placement in children was evaluated.

Endoscopic-Assisted Burr Hole Reservoir and Ventricle Catheter Placement.

Background: Accurate positioning of a ventricle catheter is of utmost importance. Various techniques to ensure optimal positioning have been described. Commonly, after catheter placement, additional manipulation is necessary to connect a burr hole reservoir or shunt components.

Telemetric Intracranial Pressure Monitoring with the Raumedic Neurovent P-tel.

Background: Devices enabling long-term intracranial pressure monitoring have been demanded for some time. The first solutions using telemetry were proposed in 1967. Since then, many other wireless systems have followed but some technical restrictions have led to unacceptable measurement uncertainties.

Aqueductal stenting with an intra-catheter endoscope--a technical note.

Introduction: Aqueductoplasty as well as aqueductal stenting is an accepted therapy option in short-segment aqueductal stenosis and isolated fourth ventricle. Over the years, different techniques with only slight modifications by using a conventional neuroendoscope with a working sheath to introduce different instruments have been presented. In summary, the use of Fogarty balloon catheters or flexible endoscopes to pass the narrowed aqueduct is recommended.

PROSAIKA: a prospective multicenter registry with the first programmable gravitational device for hydrocephalus shunting.

Objective: Cerebrospinal fluid (CSF) overdrainage is a major problem in shunt therapy for hydrocephalus. The adjustable gravitational valve proSA allows for the first time a targeted compensation for overdrainage in the upright position without interfering with the differential pressure valve. To evaluate benefit, safety and reliability, the multicenter prospective registry PROSAIKA was conducted in 10 German neurosurgical centers.

Mononostril endoscopic transsphenoidal approach to sellar and peri-sellar lesions: Personal experience and literature review.

Objective: The endonasal endoscopic approach to skull base is still under investigation. The main goal is the minimal invasive approach to pathologies with a better rate of resection without retraction of the brain tissue. Here, the authors report their technique of transnasal endoscopic neurosurgery using a mononostril approach and its development.

Clinical and radiological findings in long-term intracranial pressure monitoring.

Background: Advantages of telemetric devices for long-term intracranial pressure (ICP) measurement have been mentioned several times in the literature. However, descriptions of associated complications are lacking. Therefore, the presented observational study focused on clinical and radiological findings after insertion of an intraparenchymal telemetric ICP monitor.

Overcoming CSF overdrainage with the adjustable gravitational valve proSA.

Background: Despite progress in shunt valve technology, CSF overdrainage is still one of the most frequent complications in shunt-treated hydrocephalus. Particularly with regard to young and adolescent patients, treatment of manifest overdrainage is complicated by several hardly influenceable factors such as increasing height and mobility. Therefore, the aim of this study was to evaluate the therapeutic efficiency of the new adjustable gravitational valve, proSA.

An operative technique combining endoscopic third ventriculostomy and long-term ICP monitoring.

Neuroendoscopy has been well established in the treatment of many neurological and neurosurgical diseases. Especially its application in occlusive hydrocephalus to restore a physiological cerebrospinal fluid circulation has been extensively examined in the past. Although such procedures are believed to be safe and effective, complication as well as failure rates up to 20% have been described pointing to the importance of long-term postoperative care.

Computed tomographic angiography as a useful adjunct in the diagnosis of brain death.

Background: Because of its widespread accessibly, computed tomographic angiography (CT-A) is a promising technique in the detection of intracranial circulatory arrest in brain death (BD). Several studies assessed this tool, but neither have standardized evaluation parameters been developed nor has information about specificity become available.

Methods: We conducted a prospective study between January 2008 and April 2012.

Electromagnetic-guided neuronavigation for safe placement of intraventricular catheters in pediatric neurosurgery.

Object: Ventricular catheter shunt malfunction is the most common reason for shunt revision. Optimal ventricular catheter placement can be exceedingly difficult in patients with small ventricles or abnormal ventricular anatomy. Particularly in children and in premature infants with small head size, satisfactory positioning of the ventricular catheter can be a challenge.

Low platelet counts after induction therapy for childhood acute lymphoblastic leukemia are strongly associated with poor early response to treatment as measured by minimal residual disease and are prognostic for treatment outcome.

Background: Numerous reports have been published on the association between kinetics of leukemic cells during early treatment of childhood acute lymphoblastic leukemia and therapeutic outcome. In contrast, little is known about the prognostic relevance of normal blood counts in this setting.

Design And Methods: Normal hematopoiesis during and after induction treatment (days 8, 15 and 33) was correlated with therapeutic outcome in a cohort of 256 children with acute lymphoblastic leukemia treated in one of three consecutive ALL-BFM trials at a single institute.

First clinical results with a new telemetric intracranial pressure-monitoring system.

Background: The knowledge of intracranial pressure (ICP) is the basis of an appropriate neurosurgical treatment. Because clinical, fundoscopic, or radiological data alone are often elusive, a pre- or postoperative long-term monitoring of the ICP itself is desirable.

Objective: We describe the first clinical experiences with a new telemetric ICP-monitoring device.

Safety and efficacy of microporous polysaccharide hemospheres in neurosurgery.

Background: Effective hemostasis is mandatory for brain tumor surgery. Microporous polysaccharide hemosphere (MPH) powder, a white powder compounded from potato starch, was recently introduced for surgical and emergency application.

Objective: To evaluate the safety and efficacy of MPHs in brain tumor surgery.

Waterjet dissection of peripheral nerves: an experimental study of the sciatic nerve of rats.

Background: Although waterjet dissection has been well evaluated in intracranial pathologies, little is known of its qualities in peripheral nerve surgery. Theoretically, the precise dissection qualities could support the separation of nerves from adjacent tissues and improve the preservation of nerve integrity in peripheral nerve surgery.

Objective: To evaluate the potential of the new waterjet dissector in peripheral nerve surgery.

New applicator improves waterjet dissection quality.

Objective: Waterjet dissection is accomplished with Helix Hydro-Jet, but a new device with improved operative handling and potentially superior dissection qualities has been developed.

Materials And Methods: Eighty-four fresh cadaveric pig brains were simultaneously cut with Helix Hydro-Jet and Erbejet 2. A commonly used applicator and a new applicator for the Helix Hydro-Jet were directly compared to the new Erbejet 2.

Electromagnetic ventilation: first evaluation of a new method for artificial ventilation in humans.

Current methods of artificial ventilation cannot prevent diverse problems associated with mechanical ventilation. In contrast to all current forms of mechanical ventilation, electromagnetic stimulation can activate respiratory muscles directly. However, it is not known if and to what extent electromagnetic stimulation can ventilate humans.

Posterior calvarial augmentation in premature craniosynostosis: a technique avoiding foreign implants or free bone flaps.

Background: A surgical technique of posterior calvarial augmentation without the use of plates or screws and avoiding the formation of free bone flaps is described.

Discussion: Three infants with strong occipital flattening successfully underwent the procedure in their first year of life. There were no intra- or postoperative complications; the amelioration of the head shape and the cosmetic results in all three cases were convincing also in the long term.

Treatment of recurrent trigeminal neuralgia due to Teflon granuloma.

Recurrent trigeminal neuralgia after microvascular decompression (MVD) may be due to insufficient decompression, dislocation of the implant to pad the neurovascular contact, or the development of granuloma. Here, we report on our experience with Teflon granuloma including its treatment and histopathological examination. In a series of 200 patients with trigeminal neuralgia MVD was performed with Teflon felt according to Jannetta's technique.

Waterjet dissection in pediatric cranioplasty.

Object: Waterjet dissection has been shown to separate tissues of different resistance, with preservation of blood vessels. In cranioplasty, separation of subcutaneous tissue and dura mater is often difficult to achieve because the various tissue layers strongly adhere to each other after decompressive craniotomy. In the present study, the potential advantages and drawbacks of the waterjet technique in cranioplasty after craniectomy and duraplasty are addressed.

Waterjet dissection of the vestibulocochlear nerve: an experimental study.

Object: Waterjet dissection has been shown to protect intracerebral vessels, but no experience exists in applying this modality to the cranial nerves. To evaluate its potential, the authors examined waterjet dissection of the vestibulocochlear nerve in rats.

Methods: Lateral suboccipital craniectomy and microsurgical preparation of the vestibulocochlear nerve were performed in 42 rats.