Haemodynamic effectiveness of nimodipine on spastic brain vessels after subarachnoid haemorrhage evaluated by the transcranial Doppler method. A review of clinical studies.

The authors review the literature reports and own results of a double-blind study of the effectiveness of nimodipine on prevention or treatment of spasm of cerebral arteries following subarachnoid haemorrhage (SAH). Spasm has been evaluated using the transcranial Doppler method (TCD). The patients were divided into two groups which received 2 resp.

The microvascular Doppler--an intraoperative tool for the treatment of large and giant aneurysms.

One of the problems especially associated with large and giant aneurysms is the control of the patency of the parent artery and the exclusion of the aneurysm. While the exclusion can be tested by puncture (which may sometimes be problematic), the patency can only be controlled by intraoperative angiography or recently, by microvascular intraoperative Doppler. The device we use has a high resolution and is equipped with probes as small as 0.

Time course of blood velocity changes related to vasospasm in the circle of Willis measured by transcranial Doppler ultrasound.

Fifty patients with ruptured aneurysms were operated on within 72 hours after the first subarachnoid hemorrhage (SAH). To prevent symptomatic vasospasm, the patients were given the calcium channel blocker, nimodipine, intravenously (2 mg/hr) for 14 days and orally (60 mg four times daily) for another 7 days. At short intervals (at least every 3rd day) the blood flow velocity in the different segments of the circle of Willis was measured with a noninvasive transcranial Doppler ultrasonography method.

Incidence of wound infection in patients undergoing craniotomy: influence of type of shaving.

How the method of shaving affects the incidence of deep postoperative wound infections was examined in 475 patients. It is shown that the rate of infection is not lower after wet shaving than after dry shaving. The overall infection rate was 4.

CT-ventriculography to control the passage of cerebrospinal fluid. Technical note.

In conventional ventriculography used to confirm free passage of cerebrospinal fluid (CSF), bony overprojections often makes it difficult to visualize the contrast medium in the cranio-spinal subarachnoid spaces. CT-ventriculography offers an alternative. Because of the high density resolution, even small amounts of contrast material can be seen in the subarachnoid spaces of the cranio-cervical region.

A new safety device to prevent bleeding complications during stereotactic biopsy--the "stereotactic" Doppler sonography. Technical note.

To further reduce the incidence of haemorrhagic complications during stereotactic biopsy, the use of a microvascular Doppler system is proposed. The microprobes are fitted into the biopsy cannula to detect vessels in the neighbourhood of the target point. The first clinical results are promising.

[Extracranial aneurysms of the internal carotid artery--an otorhinolaryngologic problem?].

The problem of high cervical internal carotid aneurysms is demonstrated in two patients. One patient presented with a massive intermittent bleeding in the nasopharynx, the second with a sudden paralysis of the cranial nerves 9-12. 2/3 of these extracranial internal carotid aneurysms are situated at the bifurcation of the common carotid artery and 1/3 are located proximal the skull base.

Nimodipine and early aneurysm operation in good condition SAH patients.

A prospective open multicenter study on the preventive effect of nimodipine on symptomatic vascular spasm was performed in 120 (consecutive) patients with aneurysmal subarachnoid haemorrhage (SAH). All patients underwent early surgery (i.e.

[Temporary preoperative balloon catheter blockage of a traumatic giant aneurysm and of an a.v. fistula of the vertebral artery].

A new method of embolisation with a dilatation catheter is described as an example in a case with traumatic aneurysm and an a.v. fistula of the vertebral artery.

Transcranial Doppler sonography and its application in extracranial-intracranial bypass surgery.

Transcranial Doppler sonography is a new non-invasive technique to measure atraumatically intracranial haemodynamics. The Doppler principles and the investigative procedure with respect to the cranio-cerebral topography in normal subjects are described. Normal blood flow velocities in the circle of Willis and the influence of age and CO2-pressure are discussed in Part I.

Early aneurysm operation and vasospasm. Intracranial Doppler findings.

Modern ultrasonic Doppler systems enable us for the first time to carry out intraoperative and pre- and postoperative investigations of the circle of Willis. The application of Doppler in acute aneurysm surgery provided the following information: During the first 3 days following subarachnoid bleeding from a cerebral aneurysm, no signs of vasospastic reaction were found by Doppler sonography. Thereafter, 90% of all patients operated on in the acute stage demonstrated localized acceleration as a sign of vasospasm, despite prophylactic nimodipine treatment.

Long-term effects of partial callosal lesions. Preliminary report.

Ten patients with partial callosal lesions were investigated with a broad scale neuropsychological assessment. Nine patients with a variety of lesions affecting midline structures have been operated using a direct transcallosal approach, one patient with a callosal lipoma remained unoperated. Sophisticated studies of the interhemispheric transfer of somaesthetic and perceptual motor tasks, as well as psychometric testing related to parameters of memory and attention performance were applied.

Supratentorial space occupying lesions following infratentorial surgery early diagnosis and treatment.

Supratentorial complications of infratentorial surgery are rare. In the last 3 years we have operated on 187 patients with infratentorial lesions and have observed an incidence of 3.7% of supratentorial haemorrhages.

Possibilities and limits of the midline interhemispheric approach.

Based on experience in 17 children operated upon between 1978 and 1984, the possibilities and limitations of the interhemispheric parafalx approach to lesions of the anterior and posterior lateral ventricles and the third ventricle are described. The interhemispheric approach seems more advantageous than transcortical approaches since additional cortical and white matter lesions can be avoided. The limitations of visibility are the same as in transcortical approaches.

Use of a malar bone graft to augment skull-base access.

An anterolateral transfacial approach for tumors of the retromaxillary space, the nasopharynx, and the middle cranial fossa features a temporary removal of the malar complex and resection of the coronoid process and the pterygoid plates. Two cases demonstrate use of this approach. Results and complications are observed in six patients.

[Transcranial Doppler sonography in neurosurgery].

Using a 2 MHz transcranial Doppler sonographic system, it has become possible to measure flow velocities in the large basal vessels of the circle of Willis through thin areas of the cranial bone. After having used the method for one year on patients with neurovascular diseases, we now know that it can be employed as a matter of routine, after one has become familiar with it, and that it is of great diagnostic value. Knowing the measuring depth, achived by range gating, and with the aid of compression tests and standardised recording angles, it is possible to reliably identify the investigated vessel sections.

[Microvascular intraoperative Doppler sonography].

The use of Doppler sonographic equipment transmitting pulsed high-frequency (20 MHz) ultrasound in conjunction with miniaturised probes, allowed recordings from small brain vessels having diameters of 1 mm and less. Experience made with this technique in clinical and experimental neurosurgery demonstrated its value in all types of neurovascular operations. Nearly 10% of the immediate results of such operations, though apparently successful or without adverse findings, eventually proved unsatisfactory on Doppler sonography only and could be subsequently corrected.

[Recurrence following burr hole trephination of chronic subdural hematomas].

In a consecutive series of 100 patients suffering from Chronic subdural haematomas, which were treated by burr-hole evacuation and closed external drainage, in 23 patients repeated operations became necessary. The reasons for further operations were: true recurrences in 11 cases, superimposed haematomas in five cases and haematomas on the opposite side in seven cases. All these patients were treated again by burr-hole evacuation and closed external drainage.

[Surgical therapy of glomus jugulare tumors].

A one-stage resection of large glomus jugulare tumours with intra- and extracranial extensions is described. The patient is placed in the sitting position. Monitoring minimizes the danger of air embolism.

[Surgical approach in tumors of the nasopharynx and the retromaxillary region in childhood].

Continuous development of well established operative techniques have widened the indication for surgery of epipharyngeal and retromaxillary tumours. The authors describe an antero-lateral and infratemporal approach for complete removal of intra- and extracranial fibromas without preoperative embolisation, radiotherapy and ligation of the carotid arteries.

[Pediatric craniocerebral injuries requiring surgical treatment].

A survey is given of the craniocerebral traumas in children necessitating surgical treatment. The particularities of craniocerebral traumas in children are contrasted to those in adult persons. Diagnostic possibilities and consequences of the injury are discussed.

Intra- and perioperative aspects of the hemodynamics of supratentorial AV-malformations.

The risks which result from hemodynamic changes after surgery of 35 patients with supratentorial arterio-venous angiomas were investigated. With the help of a miniaturized 20 MHz Doppler probe flow and resistance were measured before, during, and after operations. The Doppler findings were compared with pre- and postoperative angiograms and intraoperative surgical findings.

Combined retractor and hand-rest system for neurosurgery.

A combined self-retaining retractor and hand-rest system for neurosurgery is presented. It was developed from the original Leyla system but has the advantage of an integrated hand-rest.

Intraoperative Doppler and real time sonography in neurosurgery.

Ultrasound Doppler sonography with miniaturized probes and high resolution offers new possibilities of intraoperative control of neurovascular procedures. Patency, flow direction stenoses and changes in resistance can be investigated atraumatically, repeatedly and without additional preparation. In bypass and aneurysm surgery, about 10% of the cases were shown by Doppler examinations to be unsatisfactory, with stenoses and occlusions.

Ultrasonographic diagnosis of brain tumors in infancy.

Fourteen intracranial tumors were diagnosed by means of mechanical sector scanning through the infant's open fontanelle in a series consisting of 1150 examinations. In addition, integrated pulsed Doppler-sonography (duplex-scan technique) was used to diagnose malformations of intracranial vessels. We established five diagnostic criteria: high echogenic structures are mostly seen in solid tumors of the periventricular region; low echogenic structures are seen in infiltrating tumors of the cerebral tissue and they are difficult to recognize; echo-free structures correspond with a cystic process, a necrosis or malformation of vessels; indirect sonographic signs of a cerebral tumor are all changes in shape and size of the normal anatomic structures; and abnormal blood-perfusion of a marked region, e.