Symptomatic Intracranial Hemorrhage after Dural Tear in Spinal Surgery-A Series of 10 Cases and Review of the Literature.

Objective: Intracranial hemorrhage (IH) after spinal surgery is a rare but potentially life-threatening complication. Knowledge of predisposing factors and typical clinical signs is essential for early recognition, helping to prevent an unfavorable outcome.

Methods: A retrospective analysis was performed of patients with IH after spinal surgery treated in our institution between 2012 and 2018.

Safety and Accuracy of Ultrasound-guided Burr Hole Brain Abscess Aspiration.

Background:  Ultrasound-guided burr hole biopsies or catheter placements are quick and safe procedures. The use of these procedures for treatment of brain abscesses has been reported, but larger series are missing. The aim of our study was to evaluate the accuracy and safety of the methods.

Polyether Ether Ketone Cranioplasties Are Permeable to Diagnostic Ultrasound.

It is a common assumption that the human skull and solid skull implants are impermeable to diagnostic ultrasound. We demonstrated in 2 patients that frontoparietal polyetheretherketone cranioplasties allowed useful imaging of intracranial parenchymal and vascular structures with higher ultrasound frequencies than the 2 MHz used for the temporal bone window. This knowledge about additional imaging properties may be helpful in emergency situations and for vascular monitoring.

The value of intraoperative ultrasonography during the resection of relapsed irradiated malignant gliomas in the brain.

Purpose: The aim of this study was to investigate whether intraoperative ultrasonography (IOUS) helped the surgeon navigate towards the tumor as seen in preoperative magnetic resonance imaging and whether IOUS was able to distinguish between tumor margins and the surrounding tissue.

Methods: Twenty-five patients suffering from high-grade gliomas who were previously treated by surgery and radiotherapy were included. Intraoperatively, two histopathologic samples were obtained a sample of unequivocal tumor tissue (according to anatomical landmarks and the surgeon's visual and tactile impressions) and a small tissue sample obtained using a navigated needle when the surgeon decided to stop the resection.

Real-time ultrasound monitoring during intracranial needle biopsies: operative results and detection of complications in 100 cases.

Objective: Intraoperative ultrasound displays dynamic processes intraoperatively. Performing burr-hole biopsies under a real-time visual control is an interesting option for the neurosurgeon. However, the percentage of conclusive diagnoses obtained by this technique and the rate of complications must be evaluated in a larger series.

Irrigation can cause prolonged intracranial pressure elevations during endoscopic treatment of intraventricular haematomas.

Background: Irrigation may elevate the intracranial pressure (ICP) during neuroendoscopic procedures. It is unlikely that rinsing the ventricles during routine endoscopic ventriculostomy causes persistent neurological impairment or damage, but procedures such as the endoscopic evacuation of intraventricular haematomas (IVH) are performed in patients who may be prone to elevated ICP. We report a series of such patients in which we measured the ICP intraoperatively.

An ultrasound study of brain tissue biomechanics in patients following craniectomy.

So far, little attention has been paid to the biomechanical aspects of decompressive craniectomy. The brain tissue deformation occurring in these patients is difficult to quantify. Twenty-six patients suffering from a large bone defect after craniectomy were examined in supine position.

Candidate genes for sensitivity and resistance of human glioblastoma multiforme cell lines to erlotinib. Laboratory investigation.

Object: The authors have previously reported that erlotinib, an EGFR tyrosine kinase inhibitor, exerts widely variable antiproliferative effects on 9 human glioblastoma multiforme (GBM) cell lines in vitro and in vivo. These effects were independent of EGFR baseline expression levels, raising the possibility that more complex genetic properties form the molecular basis of the erlotinib-sensitive and erlotinib-resistant GBM phenotypes. The aim of the present study was to determine candidate genes for mediating the cellular response of human GBMs to erlotinib.

Self-help activities of brain tumour patients and their relatives.

Background: To date, little is known about self-help activities including the acquisition and distribution of information among brain tumour patients and their relatives. The aim of our study was to elucidate patient characteristics, methods of networking and the impact on further treatment.

Methods: A German questionnaire was distributed at nationwide patient meetings and via internet forums.

A remote control for intraoperative ultrasound--is it really necessary?

Background: A remote control, which can be used to manipulate the scanner functions remotely from within the sterile field, is designed to save time during IOUS. This study was designed to evaluate whether the time saved by using a remote control should be a decisive factor in buying a special system.

Methods: During 50 intracranial operations, the temporary arrest of the operative procedure caused by the use of ultrasound was measured.

Retrieval of foreign bodies adjacent to the nervous system: aspects of intra-operative use of ultrasound.

The retention of a foreign body during a surgical procedure or the inadvertent migration of an implant are rare but potentially harmful complications. Especially in the case of the former, the legal situation is unequivocal. Nevertheless, the uncomplicated removal and limitation of the operative trauma may be in the interest of the surgeon.

Lumbar subdural haematoma after temporomesial resection in epilepsy patients--report of two cases and review of the literature.

We present two cases of lumbar subdural haematoma, both occurring after an uneventful temporomesial focus resection in patients suffering from medically intractable epilepsy. Initial symptom was back pain and sciatica 4 days and 13 days postoperatively, but no neurological deficits were observed. The diagnosis was confirmed by MRI.

Intra-operative diagnosis and image-guided management of an intracerebral haemorrhage occurring during ultrasound-guided biopsy.

Haemorrhagic complications occurring after burr-hole procedures are diagnosed only in symptomatic patients or when postoperative imaging is performed routinely. We report the development of an intracerebral haematoma which occurred during ultrasound-guided burr-hole biopsy. Real-time ultrasound through the same burr-hole enabled us to determine the dynamics of the bleeding and its terminal volume.

Minimally invasive neurosurgery within a 0.5 tesla intraoperative magnetic resonance scanner using an off-line neuro-navigation system.

Background And Purpose: We evaluated an advanced concept for patient-based navigation during minimally invasive neurosurgical procedures.

Methods: An infrared-based, off-line neuro-navigation system (LOCALITE, Bonn, Germany) was applied during operations within a 0.5 T intraoperative MRI scanner (iMRI) (Signa SF, GE Medical Systems, Milwaukee, WI, USA) in addition to the conventional real-time system.

Intrinsic brainstem tumours in adults: results of microneurosurgical treatment of 16 consecutive patients.

Intrinsic brainstem tumours in adults have a poor prognosis and surgical resection is rarely performed. Encouraged by successful operations on children performed in our department, we began a more aggressive strategy of open operations. Between 1986 and 1997, we operated upon 16 consecutive patients over 16 years of age (five female, 11 male, mean age 36.

Successful treatment of multiple Pseudallescheria boydii brain abscesses and ventriculitis/ependymitis in a 2-year-old child after a near-drowning episode.

Rationale: We report on a cerebral infection by Pseudallescheria boydii in a 21-month-old boy after a near-drowning episode. MRI revealed multiple (> 60) intracerebral abscesses.

Methods: The surgical therapy included CSF drainage and microsurgical resection of one abscess for microbiological diagnosis.

Internet-based interaction among brain tumour patients. Analysis of a medical mailing list.

Patients and their care providers are increasingly turning to the internet for information. Being faced with this information of very heterogeneous quality, the physician would do well to be informed about the common internet information sources. We investigated the e-mails of a mailing list (or "support group") serving about 380 brain tumour patients and their care providers.

Trigeminal evoked potentials and sensory deficits in atypical facial pain--a comparison with results in trigeminal neuralgia.

Trigeminal evoked potentials (TEPs) and sensory deficits in eighty-three patients admitted for first surgical treatment of facial pain were retrospectively analysed. Thirty-seven patients suffered from trigeminal neuralgia (TN), 10 from symptomatic TN (sTN), and 36 from atypical facial pain (AFP). Eighteen percent of the TN patients reported sensory deficits on the pain side, but 35% had delayed ipsilateral N13 waves.

Blood flow velocities in the basal cerebral vein after head trauma: a prospective study in 82 patients.

Background And Purpose: The authors' aim was to evaluate the time course of the basal vein's (BVR) mean flow velocity (VBVR) in patients after traumatic brain injury and its relation to intracranial pressure (ICP), cerebral perfusion pressure (CPP), and the clinical outcome.

Methods: In 82 head-injured patients (13 women and 69 men, median age = 31 years, Glasgow Coma Score = 15 to 3), daily measurement of the basal cerebral vein's and the middle cerebral artery's (MCA) flow velocities and pulsatilities was performed during each patient's entire stay in the intensive care unit. No angle correction was performed.

Endothelin-converting enzyme activity in human cerebral circulation.

Objective: An increased level of endothelin (ET)-1 seems to be involved in the development of augmented cerebrovascular resistance in different pathological conditions, most notably vasospasm after subarachnoid hemorrhage. Therefore, interfering with the ET synthesis or ET receptor blockade may be a promising approach in the treatment of cerebral vasospasm after subarachnoid hemorrhage. Although the receptors mediating the effects of ET-1 human cerebrovasculature are well characterized, data concerning the functionally relevant ET-converting enzyme (ECE) activity are scarce.

Blood flow velocities in the basal vein after subarachnoid haemorrhage. A prospective study using transcranial duplex sonography.

Background: Early recognition of emerging delayed neurological deficits (DND) in patients after subarachnoid haemorrhage (SAH) is not always possible by transcranial Doppler sonography. Aim of this study was to investigate a) whether determination of blood flow velocities in deep cerebral basal veins can predict DND in these patients b) the correlation of venous flow velocity to cerebral blood flow (CBF).

Methods: a) We prospectively investigated the mean flow velocity in the basal vein (VBVR), in the middle cerebral artery (VMCA) and in the extracranial internal carotid artery (VICA) in 66 patients after spontaneous SAH.