Intracranial Aneurysms and Vascular Malformations: Diagnosis for Therapy. A Long-Term Study at a Central Hospital. A Neuroradiological Approach. Part II: 2000-2008. The Time of the Beginning with Newer Diagnostic Developments in CT, MR, DSA for Endovascular Intervention, Microneurosurgery, Radiotherapy.

In the second part of our overviewstudy the diagnosis for the treatment of our patients with intracranial vascular malformations (aneurysms / AVMF - arteriovenous malformations) is again shown in a region of about 500.000 inhabitants and just an overview of the outcome. This second part will be an overall comparison between the former diagnostic for the treatment and the here described diagnostic for the treatment (CTA, MRA, DSA rot / microsurgery, endovascular interventional techniques etc.

Intracranial Aneurysms and Vascular Malformations: Diagnosis and Therapy. A Long-Term Study at a Central Hospital. Part I: 1972-1997. The Time before Endovascular Intervention, Microneurosurgery and Radiotherapy.

The first part of our study describes the treatment of our patients with intracranial vascular malformations (aneurysms/AVMF - arteriovenous malformations) in a region of about 500,000 inhabitants. The second part will compare currrent treatment and the changes in treatment (microsurgery, endovascular interventional techniques, etc.) also in relation to topography and demography.

[Examples of controlled use of computerized tomography in soft tissue injuries of the area of the head and neck].

CT can be utilised in a selective manner in soft tissue injuries presented in the head, neck and shoulder regions.

[Radiation dosage and clinical value of conventional tomography and high resolution computerized tomography of the nose and ear].

Hypocycloidal (frontal and temporal) tomography of the base of the skull is compared with high resolution computed tomography (HR-CT) with respect to dose and clinical usefulness. In most cases HR-CT is indicated because of its better density resolution in comparison with conventional hypocycloidal tomography. As the X-ray beam is directed at the slice plane the dosage is noticeably less than when using conventional tomography.

[Spinal subdural space-occupying lesions--hematomas].

The rare spinal subdural masses, usually haematomas, are described in 5 patients and the importance of ascending myelography in addition to computed tomography in radiological diagnosis is emphasised.

[Synopsis of a standardized, schematic analysis of the ossicles and tympanic walls, visualized with high-resolution computed tomography (using help lines and pictograms)].

As in other radiological examinations there is an essay to show the ossicles and their surrounding tympanic walls of the petrous bone in the high resolution computed tomography. This should be standardized to simplify the interpretation and to allow the comparison. For the axial imaging of the ossicles corresponding to their particular topographic situation the head is tilted to the non-examined side and a little bit dorsally flected to turn especially the stapes in the scanning plane and to image the malleus and incus axially.

[Dislocations and fractures of the ossicles--high resolution computerized tomography of the petrous bone].

As in traumatology of the head the HR-CT of the injured petrous bone is now the imaging method of choice. With axial and coronary slices one can show not only the different parts of the ear but also the course of the facial nerve and particularly the ossicles in the tympanon. The fractures are nice to show, also the soft tissue lesions like brainprolaps in the tympanon or hematotympanon because of the better density resolution in comparison to the conventional tomography with rather higher radiation dose especially for the eye lenses.

[Excluding a recurrence of cholesteatoma using high resolution computerized tomography. Can one dispense with the second-look operation?].

In a prospective study 20 patients were examined by high-resolution computed tomography of the temporal bone (HR-CT) before an early or late second-look operation. One year earlier 8 of the patients had undergone a posterior tympanotomy ("intact canal wall" technique) for a cholesteatoma and if necessary a one-stage ossicular reconstruction. In 4 other patients a two-stage ossicular reconstruction was carried out.

[Differential diagnosis of hyperdense space-occupying lesions of the cerebral hemisphere in computerized tomography].

A CT survey of the most frequently encountered hyperdense space-occupying lesions in the region of the cerebral hemispheres. Description of differential diagnostic deliberations.

[Identification of middle ear implants in high-resolution computerized tomography].

As a result of the increase in the use of computed tomography and the possibility of demonstrating very small structures, x-ray diagnosis is becoming more and more important in investigating complications after examined in patients as well as cadaver temporal bones by using high resolution middle ear computed tomography: 1. autologous/allogenic ossicular implants, 2. alloplastic implants made of ceramic, plastic or metal.

Evaluation of the carotid bifurcation by duplex ultrasound, intravenous and intra-arterial digital subtraction angiography.

In 167 patients with cerebrovascular disorders 323 carotid bifurcations were investigated by Duplex ultrasound. In 100 of these patients, additionally intravenous digital subtraction angiography (DSA) was performed and in 35 patients, also intra-arterial DSA was carried out. In 32 patients all three procedures were performed.

[Dosage load and value of cranial angiography. A digital intravenous/intra-arterial camera (105 mm) and imaging plates].

The integral dose and the dose to the organ at risk were calculated using the following angiographic techniques: 1. Intravenous DSA in the neck, 2. Intravenous DSA in the skull, 3.

[The Eustachian tube in HR computerized tomography. Imaging in the adult].

Until now the lumen of the Eustachian tube (ET) has always been shown by using histological sections of temporal bones, which were after decalcification embedded in paraffin blocks and serially sectioned. In order to avoid changes caused by this preparations, we applied contrast medium or air to the lumen of the ET of cadaver temporal bones resected immediately after exitus. It was therefore possible to demonstrate the lumen of the tube in high resolution computed tomography.

[The eustachian tube in HR computerized tomography. Imaging in the fetus, newborn infant and infant].

The lumen of the eustachian tube in foetuses, neonates and infants was demonstrated in cadaver temporal bones immediately after death by air and contrast medium using high-resolution computed tomography with axial and coronal projections. Special consideration was given to the deviation of the tube from the sagittal and horizontal plane and the functional unit consisting of the processes of tensor palatini muscle. At this stage of development the lumen of the cartilaginous portion shows a constant almost circular form, quite unlike the shape in adults.

[Goldenhar syndrome and other ear abnormalities in HR-PCT].

The use of CT in hospitals in which also ENT departments are located will be useful in cases of osseous congenital disorders of the ear. In combination with the clinical and audiometric investigations CT of the temporal bone will be helpful for the indication of the operations to ameliorate the hearing.

[High-resolution computed tomography in stapes surgery].

Early and delayed complications in the inner or middle ear may follow stapedectomy or stapedotomy and may require revision surgery. Nowadays high resolution middle ear computed tomography (HR-MCT) using a special interpolation technique can demonstrate the smallest structures of the middle ear space, such as the long process of the incus and stapes. Stapes prostheses can also be seen in this way, but to identify the prothesis exactly it is necessary to determine the position of the piston hook in relation to the incus and of the piston shaft to the foot plate and scala vestibuli.

[Clinical and computerized tomography findings in Bourneville-Pringle phakomatosis].

The various clinical patterns of Bourneville's disease and/or Pringle's disease (pharkomatosis, or tuberous sclerosis combined with adenoma sebaceum) are described and compared with CT morphology of the neurocranium.

[Lumbosacral computed tomography and lumbosacral functional myelography. Dosimetric comparison and comparison of indications].

The integral dose and organ dose produced by spinal lumbosacral CT and lumbosacral functional myelography were compared, using a phantom. The value of these methods of investigation is discussed.

[Neoplasias of the scapula--rare causes of chronic shoulder-arm syndrome].

The diseases most frequently resulting in a chronic shoulder-hand syndrome are definitely of a post-traumatic nature and are later - after a varying period - often combined with degenerative changes. The tendency to injury is enhanced by the particularly great mobility of the shoulder joint. Inflammatory changes - e.

[Spinal epidural abscess: an interdisciplinary emergency].

On the basis of fifteen own observations in the years 1978 to 1984 as well as the literature, clinic diagnostic and therapy of epidural spinal abscess are represented. Myelography and CT are the leading methods after clinic and neurology must already lead to a hospital admission in case of the slightest signs of an incipient transverse lesion of te cord with paraplegia. Laminectomy as well as suction and through-drainage are methods of choice, conservative treatment is an exception.

[Determination of the integral dose in computer tomography of the neurocranium].

The amount of exposure of the cranium is calculated on the basis of the measured dose distribution in craniocaudal direction and on the axial planes of the Alderson phantom. The integral dose of the cranium and the local dose at sensitive organs are used as a measure of radiation exposure.

[The craniocervical transitional area: a diagnostic problem].

The case histories of six patients with spinal C1/C2 region lesions are presented. All cases were misinterpreted by clinical features and radiological findings over a long period. Radiological evaluation documents the significant improvement in diagnosis by supplementary use of computer assisted myelography.