The Usefulness of Intraoperative Cerebral C-Arm CT Angiogram for Implantation of Intracranial Depth Electrodes in Stereotactic Electroencephalography Procedure.

Background: Stereotactic electroencephalography (SEEG) is an invasive diagnostic tool for localizing the epileptic zone in patients with medically refractory focal epilepsy. Despite technical and imaging advances in guiding the electrode placement, vascular injury is still one of its most serious complications.

Object: To investigate the usefulness of intraoperative cerebral C-arm CT angiogram (CCTA) in avoiding intracranial hemorrhagic complications during SEEG electrode implantation.

Subdural Hematoma and Oral Anticoagulation: A Therapeutic Dilemma from the Neurosurgical Point of View.

Background: Oral anticoagulation is a common prophylactic therapy for several diseases with a high thromboembolic risk. Such medication harbors a possible hemorrhage risk, with a special risk for subdural hematoma (SDH). The safety and efficacy of resumption of oral anticoagulation versus long-term discontinuation has not been fully clarified in patients who experienced SDH while under treatment with oral anticoagulation.

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.

Systemic inflammatory effects of traumatic brain injury, femur fracture, and shock: an experimental murine polytrauma model.

Objective: Despite broad research in neurotrauma and shock, little is known on systemic inflammatory effects of the clinically most relevant combined polytrauma. Experimental investigation in an animal model may provide relevant insight for therapeutic strategies. We describe the effects of a combined injury with respect to lymphocyte population and cytokine activation.

Subacute steroid-induced paraparesis: surgical treatment of a devastating "invisible" side effect.

Purpose: To emphasize an underestimated side effect following long-term use of steroids.

Methods: We report on surgical treatment of two patients with serious neurologic deficits caused by epidural spinal lipoma following long-term intake of cortisone.

Results: Early decompression of the spinal cord by removal of epidural lipoma was the most effective treatment in these patients with progressive symptoms.

MRI safety of a programmable shunt assistant at 3 and 7 Tesla.

Objective: Several new shunt technologies have been developed to optimize hydrocephalus treatment within the past few years. Overdrainage, however, still remains an unresolved problem. One new technology which may reduce the frequency of this complication is the use of a programmable shunt assistant (proSA).

Stereotactic versus endoscopic surgery in periventricular lesions.

Object: Endoscopic and stereotactic surgery have gained widespread acceptance as minimally invasive tools for the diagnosis of intracerebral pathologies. We investigated the specific advantages and disadvantages of each technique in the assessment of periventricular lesions.

Method: This study included a retrospective series of 70 patients with periventricular lesions.

Histopathological features of the brain, liver, kidney and spleen following an innovative polytrauma model of the mouse.

Object: Among the various introduced experimental traumatic brain injury models, there is a clear paucity of proper experimental polytrauma models. To overcome this experimental gap we introduced such a polytrauma model in the mouse including traumatic brain injury. Here, we report on the histopathological features of the brain, lung, kidney, spleen and liver.

Extended long-term (> 5 years) outcome of cerebrospinal fluid shunting in idiopathic normal pressure hydrocephalus.

Background: Shunt surgery has been established as the only durable and effective treatment for idiopathic normal pressure hydrocephalus.

Objective: We evaluated the "extended" long-term follow-up (> 5 years) in a prospective study cohort who underwent shunting between 1990 and 1995. A secondary objective was to determine the cause of death in these patients.

The adjustable proGAV shunt: a prospective safety and reliability multicenter study.

Objective: To evaluate the reliability of the gravitation-assisted adjustable proGAV shunt system with a prospective multicenter study conducted in 10 German hospitals.

Methods: Enrollment for this observational study began in April 2005 and concluded in February 2006. The protocol required re-examinations 3 and 6 months postoperatively and fixed the endpoint of follow-up at 12 months after implantation.

The diagnostic value of erythrocyte sedimentation rate in management of brain tumors.

Objective: Erythrocyte sedimentation rate (ESR) is considered as an indicator of inflammatory processes, and it has a prognostic value in the management of specific neoplastic diseases. It also responds to surgical intervention. There is very little data about the alteration of ESR in patients with brain tumors and information on its course after intracranial tumor surgery is completely lacking.

Exophytic giant cell glioblastoma of the medulla oblongata.

Giant cell glioblastoma is a rare variant within the spectrum of glioblastoma multiforme (GBM) tumors. A giant cell glioblastoma may be associated with a better prognosis than the common type of GBM after combined treatment involving tumor resection and radiochemotherapy. A giant cell glioblastoma may occur at various sites in the brain and spinal cord.

Modified calcium accumulation after controlled cortical impact under cyclosporin A treatment: a 45Ca autoradiographic study.

Objective: As a neuroprotective drug, cyclosporin A (CsA) has been subject of multiple experimental works in traumatic brain injury (TBI) research. It is well known that CsA inhibits calcium (Ca2+) induced mitochondrial permeability transition (mPT). The aim of this study was to investigate the influence of CsA on the alteration of Ca2+ homeostasis after experimental brain injury.

Systemic effects of isolated brain injury: an experimental animal study.

Objective: Although various experimental works of neurotrauma research are performed, little attention has been paid to the concomitant systemic changes following isolated traumatic brain injury (TBI). Such investigations seem to be a prerequisite condition for evaluation of experimental drugs, which may diminish the secondary damage following TBI. We describe histopathologic findings of the lung, liver, spleen and kidney 96 hours following an experimental TBI.

Image-guided craniotomy for frontal sinus preservation during meningioma surgery.

Objective: Preservation of the frontal sinus (FS) during the frontolateral approach to the skull base reduces morbidity, enhances patient comfort, and speeds up the surgical procedure. Due to its irregular outline, mental reconstruction of the borders of FS from two-dimensional images is challenging during surgery. This study was designed to evaluate the impact of neuronavigation on identification and preservation of the FS during frontolateral craniotomies.

The use of high-frequency electromagnetics in brain tumour surgery.

Objective: The first commercially available high-frequency electromagnetic field (EMF) system promises additional functionality for neurosurgical procedures. In a prospective study, we evaluated the optimal use as well as the limitations of this system designed for vaporizing tissue and for coagulation in brain tumour surgery.

Methods: For the microsurgical treatment of 63 consecutive patients with various intracranial tumours, the EMF system was used in addition to the standard neurosurgical instrumentarium.

Chordomas of the skull base: surgical management and outcome.

Object: The goal of this study was to report on the surgical management of skull base chordomas and to evaluate both the short- and long-term treatment outcomes.

Methods: The authors retrospectively studied data from 49 patients who had undergone consecutive surgeries at a single institution. They also analyzed patterns of chordoma extension.

Cavernous hemangioma of the cavernous sinus, skin, and retina: hemodynamic changes after treatment: case report.

Objective: There are several reports concerning cavernous hemangiomas of the skin and central nervous system. Additional retinal involvement has also been reported.

Clinical Presentation: The authors report a 69-year-old woman with a giant extra-axial cavernous hemangioma of the right cavernous sinus involving the supra- and parasellar region, retina, and skin.

Ventriculoperitoneal shunt dysfunction in a patient presenting with neurogenic pulmonary edema. Case report.

The authors report on a patient with dysfunction of a ventriculoperitoneal shunt who presented with two episodes of neurogenic pulmonary edema within the space of a few months. The edema resolved on correction of the shunt dysfunction. Because neurogenic pulmonary edema may be a rare consequence of shunt dysfunction, it is important to recognize this unusual association and provide appropriate diagnostic measures and treatment.

Response of C-reactive protein after craniotomy for microsurgery of intracranial tumors.

Objective: C-reactive protein (CRP) is used as an indicator of inflammatory processes. However, its expression is unspecific and will increase after surgery. Without normative data on its regular course after craniotomy, postoperative infection can barely be detected or excluded.

Management of vestibular schwannomas in young patients-comparison of clinical features and outcome with adult patients.

Objects: Vestibular schwannomas (VS) in young patients are rare. They are regarded to have different biological characteristics. Our objective is to analyze a series of such patients, with respect to their clinical presentation, treatment, and outcome and to compare the results to a matched series of adult patients.