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Biomedical subjects

A Kühner

Publications and source records attributed to A Kühner.

At least 19 recordsLinked to original sources
PubMed1999

Ultrasound-guided puncture of a Dandy-Walker cyst via the lateral and III ventricles.

Since the Dandy-Walker syndrome was first described by Dandy and Blackfan, Taggart and Walker, the many variants of posterior fossa anomalies, the appropriate management of these malformations and the clinical outcome have been the subjects of controversy. Surgery of the posterior fossa with membrane excision was initially the preferred method of treatment. Unfortunately, there was a high rate of complications, and many of the patients treated in this way still needed a shunting system. Ventricular-peritoneal and/or cysto-peritoneal shunting is commonly used to treat symptomatic posterior fossa cysts of Dandy-Walker malformations and hydrocephalus. Cysto-peritoneal shunt implantation only was associated with a high rate of complications, and most patients so treated needed a ventriculo-peritoneal shunt in addition. According to the literature, combined ventriculo-peritoneal and cysto-peritoneal shunting is needed for satisfactory decompression of Dandy-Walker cyst and hydrocephalus in between 16% and 92% of cases. We report on a young patient with a Dandy-Walker malformation who needed drainage of the posterior fossa and a ventricular shunt. We decided to drain the cyst and the supratentorial ventricles via a single, especially prepared, catheter with many perforations. The catheter was inserted under ultrasound guidance. The tube was inserted from the left lateral ventricle through the foramen of Monro into the III ventricle and downwards into the cyst. Intraoperatively, an immediate decrease in the size of the cyst and the supratentorial ventricles was observed. Postoperative MRI confirmed the exact position of the catheter and sufficient drainage of the posterior fossa cyst and the ventricles. Six months later the girl was seen in our outpatient department. Clinical examination showed no neurological deficit, and MRI demonstrated sufficient drainage of the ventricles and the Dandy-Walker malformation, and in addition hypoplasia of the corpus callosum.

Adult↗
PubMed1988

[Pseudotumor forms of spontaneous intracerebral hematomas].

Pseudotumorous types of spontaneous intracerebral haematomas are known from clinical or radiological publications. To our knowledge no study has been conducted dealing with both aspects. A series of 13 cases of spontaneous intracerebral haematomas operated upon as tumours, is reported. In 11 cases the association of atypical clinical course and atypical CT led to the diagnostic error. In 2 cases atypical CTs were erroneous despite a typical clinical course. The atypical clinical features were a progressive course or seizures. The atypical CT findings concerned prolonged hyperdensities, contrast enhancement, ring-shaped and hypodense areas. After discussion of these various findings the authors conclude that a tumour can never be excluded definitely in such cases, and advocate definitive clearing of diagnosis by operation or stereotactic biopsy.

Brain Neoplasms↗
PubMed1988

[The value of destructive surgery of the trigeminal nerve in atypical facial pain].

Interruption of trigeminal pathways still is a common treatment in trigeminal neuralgia and has also been suggested for atypical facial pain. The published results in the latter group are rather poor since only 17 to 24% of these patients were free from pain after surgery. There is no information on the outcome of those patients classified as "poor results". We had the opportunity of seeing 48 patients who had been treated without success elsewhere. Pain occurred in most cases after ETN or dental operations. 36 patients underwent, despite poor results after a first neurosurgical intervention, further (up to five) operations. In 58% a postoperative deterioration occurred mainly consisting of anaesthesia dolorosa. Suicidal attempts were four times more frequent than in the group of those patients who had merely not benefited from surgery. In conclusion, the poor results of trigeminal surgery reported in literature and the considerably high risk of postoperative deterioration, as shown in our series, prompt us to warn against destructive trigeminal surgery in atypical facial pain.

Facial Pain↗
PubMed1985

Pharmacokinetics and CSF penetration of moxalactam in antibiotic prophylaxis in neurosurgery.

Moxalactam, a new oxa-beta-lactam antibiotic, suggests a possible role in prophylaxis in neurosurgery. Therefore, CSF penetration of Moxalactam was determined in 12 patients with absence of clinical or laboratory evidence of meningitis. In the dose employed (25 mg/kg 3 times/day) CSF samples showed a penetration of Moxalactam through the blood-cerebrospinal barrier with concentrations higher than 0.1 microgram/ml which persisted for more than seven hours. The drug was well tolerated and adverse effects were not observed.

Adult↗
PubMed1984

Neurosurgical treatment of cancer pain.

Neurosurgical pain operations in carcinoma patients should always be considered when conservative treatment methods fail or pain relief can be attained only at the cost of undesired side effects. The therapeutic spectrum of neurosurgery has been appreciably extended in recent years. Due to the introduction of percutaneous surgery methods, the operations have become less burdensome, so that carcinoma patients who were formerly regarded as inoperable can also be given neurosurgical pain treatment. The advances in neurophysiology have led to a better understanding of pain mechanisms, in consequence of which the various possibilities of treatment can be employed more specifically with prospects of better treatment results. The spectrum of neurosurgical treatment extends from destructive measures (rhizotomies, cordotomies, thalamotomies, neurolytics) via intrathecal administration of morphine-like substances to the augmentative nondestructive neurostimulation techniques. Despite the advances in conservative therapy of cancer pain, in many cases, a neurosurgical procedure is most efficacious in controlling carcinoma pain.

Cordotomy↗
PubMed1979

Chronic electrical stimulation of the thalamic unspecific activating system in a patient with coma due to midbrain and upper brain stem infarction.

Chronic intermittent bipolar electrical stimulation of the left nucleus reticulatus polaris thalami was performed in a patient in a state of subcoma due to ischaemic infarction of wide medial parts of the midbrain, mainly the tegmentum, and the right-sided mediobasal parts of the forebrain. Stimulation immediately resulted in autonomic reactions and behavioural arousal reactions during the periods of stimulation. Longterm effect consisted of a rise in the level of clinical responsiveness for a period of seven weeks. A preexistent severe pneumonia disappeared completely after one week of stimulation and returned after seven weeks. The results are discussed on the basis of the pathoanatomical findings and of the physiological functions of the damaged as well as of the stimulated areas.

Aged↗
PubMed1977

[Lesions of the cauda equina after dimer-X myelography (author's transl)].

The authors describe five cases of an uncommon complication after Dimer X Myelography consisting in a more or less complete lesion of the caudia equina. Up to the present only seven similar cases have been reported in the literature. The evolution and the clinical symptoms of these cases were similar to those reported by others. While in the cases presented the clinical outcome was favourable, with complete recovery in all cases, less favourable evolutions with definitive neurological symptoms are described by others.

Acute Disease↗
PubMed1976

[Oerations on peripheral nerves, plexus and nerve roots, including subarachnoid block with phenol in chronic pain (author's transl)].

Peripheral surgery was performed in 112 patients. Neurolysis or resection of neurons gave rather poor results in pain after nerve injury and stump pain. Rhizotomy is considered to be more effective in those cases. Rhizotomy is also successful in radicular, especially coccygeal, pain syndromes. Subarachnoid blocks with Phenol gave similar promising results. Causalgia responds well in a high percentage of cases to sympathectomy; cases of postherpetic neuralgia phantom pain and tabetic crises generally do not respond to peripheral surgery.

Analgesia↗
PubMed1976

Arteriovenous malformations of the transverse dural sinus.

Clinical, radioanatomical, and therapeutic aspects of dural arteriovenous malformations in the region of the transverse sinsu are discussed on the basis of seven personal observations and the analysis of 72 reported cases. Common symptoms are headache and troublesome tinnitus aurium. More serious neurological deficiencies may occur as a result of distrubance in cerebral hemodynamics. A complete neuroradiological investigation is essential for adequate treatment. Most frequent arterial feeders are the occipital, tentorial, and middle meningeal arteries. Ligation of the occipital artery is not sufficient in most cases. Operative isolation of the transverse sinus by craniotomy and dural section is considered by far the most successful treatment and should be performed whenever ligations fail or are not indicated.

Aged↗
PubMed1975

[Peripheral nerve compression by ganglionic cysts (author's transl)].

Extra- and intraneural ganglionic cysts rarely involved peripheral nerves. They are found in the neighbourhood of large joints. Intraneural cysts prefer the deep peroneal nerve and cause intermittent pain and severe nerve damage. The ulnar nerve is affected most often at the wrist. There are different types of distal motor and/or sensory ulnar palsy. Spontaneous recovery may take place and recurrences of intraneural cysts of the peroneal nerve occur after surgery.

Adult↗