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Biomedical subjects

C B Lumenta

Publications and source records attributed to C B Lumenta.

At least 19 recordsLinked to original sources
PubMed1999

Congenital dilation of the cervical epidural venous plexus: neuroradiology and endovenous management.

We report a case of a 15-year-old girl suffering from cervicobrachialgia who was admitted to our service due to an enlarged neural foramen suspicious for a neurinoma. The cervical phlebography, however, revealed a space-occupying dilated epidural vein with increased blood supply from the suboccipital venous plexus. Lesions like this are absolutely rare, presumably of congenital origin and have not been described before. The lesion was treated by feeder occlusion applying platinum coils and enbucrilate via the internal jugular vein.

Adolescent↗
PubMed1999

Cerebral vasodilatation causing acute intracranial hypertension: a method for noninvasive assessment.

Deep spontaneous vasodilatatory events are frequently recorded in various cerebral diseases, causing dramatic increases (A-waves) in intracranial pressure (ICP) and subsequently provoking ischemic brain insults. The relationship between fluctuations in CBF, ICP, and arterial blood pressure (ABP) is influenced by properties of cerebrovascular control mechanisms and the cerebrospinal pressure-volume compensation. The goal of this study was to construct a mathematical model of this relationship and to assess its ability to predict the occurrence and time course of A-waves. A group of 17 severely head-injured patients were included in the study. In our model ICP was derived from the ABP waveform using a linear signal transformation. The transformation was modified during the simulation by a relationship between ABP and flow velocity, i.e., by the characterization of the cerebrovascular bed. In this way the ICP could be calculated from the ABP waveform. This model was verified by comparison of simulated and directly measured ICP during A-waves recorded in seven of the patients. In all simulations, plateau elevations of ICP were well replicated. The mean absolute error between real and simulated ICP was 8.3 +/- 5.4 mm Hg at the baseline and 7.9 +/- 4.3 mm Hg at the top of plateau waves. The correlation coefficient between real and simulated increase in ICP was R = 0.98; P < .001. Similarly, correlation between real and simulated increase in pulse amplitude of ICP was highly significant (R = 0.94; P < .001). The mathematical model of the relationship between ABP, flow velocity, and ICP is of potential clinical use for the noninvasive detection of A-waves in patients in whom invasive ICP assessment is not conducted.

Adolescent↗
PubMed1999

BrainLab VectorVision Neuronavigation System: technology and clinical experiences in 131 cases.

OBJECTIVE: The BrainLab VectorVision neuronavigation system was used in 131 cases of different brain pathological conditions. The neuronavigation system was used without problems in 125 cases. These cases included 114 microsurgical operations, 4 endoscopic procedures, 4 frameless stereotactic biopsies, and 3 catheter placements. METHODS: The BrainLab VectorVision neuronavigation system is an intraoperative, image-guided, frameless, localization system. The system consists of a computer workstation for registration of images and physical spaces, an intraoperative localization device, and a computer image display. The system provides real-time responses regarding the locations of surgical instruments. VectorVision is based on passive reflections of infrared flashes. Universal adapters with reflective markers for surgical instruments, endoscopes, and the operating microscope are used. RESULTS: In six cases, the system could not be used because of system failure or mishandling. In 125 neurosurgical cases, the neuronavigation system was useful, with a target-localizing accuracy of 4+/-1.4 mm (mean+/-standard deviation). For small cerebral lesions, we never performed an exploration with negative results. CONCLUSION: The BrainLab neuronavigation system has been shown to be very helpful and user-friendly for routine neurosurgical interventions. Its advantage lies in its mobility, based on wireless reflective adapters for surgical instruments, endoscopes, and the operating microscope.

Biopsy↗
PubMed1998

Unusual clinical presentation of a meningeal melanocytoma with seizures: case report and review of the literature.

The 17th case of an intracranial meningeal melanocytoma is presented in a 67-year old man. It is the 6th melanocytoma arising from the cavum Meckeli and the first presenting with seizures. Surgical removal was curative for a follow up period of 32 months. Besides the clinical and neuroradiological presentation, the histological, ultrastructural and immunohistochemical features are described. A review of the literature including cases with malignant transformation is given and differential diagnostic problems are discussed.

Aged↗
PubMed1998

[Multifocal hemangioblastoma in a young woman with Hippel-Lindau syndrome].

A 25 years old female person suffered from v. Hippel-Lindau disease with three manifestations within the central nervous system (cerebellum, nerve root C1 and Medulla oblongata). Pancreatic cysts, a cyst and a tumour of the kidney were diagnosed as well. In a first operation, the large cerebella's tumour and the small haemangioblastoma of the nerve root C1 were removed via a suboccipital craniectomy. A few weeks later, after the patient had made a good recovery, the tumour at the craniocervical junction was removed through a far lateral approach. The postoperative course was without complications. The MRI control seven months after surgery was free of tumour and the young person was in a good clinical condition, without neurological deficit.

Adult↗
PubMed1997

Therapeutic management of grade IV aneurysm patients.

BACKGROUND: The timing of surgery in patients suffering from subarachnoid hemorrhage grade IV and V according to Hunt and Hess, is still controversial. Several authors advocate early surgery for patients in poor clinical condition. Improved outcome and decreased mortality rates were reported. Others exclude patients in poor condition from early aneurysm surgery. METHODS: Forty grade IV aneurysm patients were admitted to our department. After ventriculostomy and cerebral angiography, 28 of them were operated on within 72 hours. The postoperative treatment included hypertensive, hypervolemic, hemodilutional therapy (triple-H therapy) and intensive monitoring (intracerebral pressure, blood pressure, hemodynamic parameters). The mean follow-up time was 6 months. RESULTS: Out of the 28 patients who underwent early surgery, 64% were in good health, 11% in poor health, 25% died; there were no survivors in a vegetative state. Twelve patients were treated conservatively; 50% died from infarction and rebleeding, before the operation was performed. Six underwent delayed aneurysm surgery after clinical improvement. In this group, 25% had good clinical outcome. CONCLUSIONS: Our results favor an aggressive treatment of grade IV aneurysm patients by means of ventricular drainage, early surgery and triple-H therapy.

Critical Care↗
PubMed1997

Three-dimensional computer-assisted stereotactic-guided microneurosurgery combined with cortical mapping of the motor area by direct electrostimulation.

TIM (Zeppelin Chirurgische Instrumente GmbH, 82 049 Pullach, Germany) is a tomographic imaging system which enables surgeons to visualize the pathologic lesions three dimensionally in relationship to the surrounding structures. The distance and the angle between the pathologic lesion and the anatomical and/or bony landmarks as well as the volume of the mass lesion can be measured. Therefore an accurate localization of the lesion is possible with this technique. It is very applicable for planning of surgery on skull base tumors. The surgical procedure for small and well-defined, intrinsic pathologic deep-seated brain lesions, however, becomes much easier by using the stereotactic techniques of this system. The target point and the direction brain-surface-to-lesion can be determined within seconds. Before the aiming probe is inserted to the target, the cortical motor area is mapped by direct electrical stimulation. The approach can be varied depending on the results of these neurophysiologic investigations of the brain surface. The dissection is made along the aiming probe up to the target point. Because of the fixation of the brain with the needle, a brain shifting due to the dissection as well as to CSF release is diminished. Forty patients with deep-seated intracerebral lesions were operated on during a 13 months period by these combined techniques in our service. Using this technique, we never made a negative exploration. In all but three patients, total removal of the mass lesion was achieved. Permanent neurological deficits were observed in two patients only. In our opinion, this combined imaging and neurophysiological technique is easy to perform, and of major benefit for the patients due to its accuracy and is preferable in comparison with other single computer localizer techniques without neurophysiological monitoring.

Adolescent↗
PubMed1996

[Intramedullary spinal metastasis of bronchial carcinoma coincident with intramedullary spinal angioma].

We report on a case of a man of 51 years, who presented with pain and symptoms of progressive spinal cord compression caused by an intramedullary spinal tumor at T8. Before surgery a bronchial carcinoma was diagnosed. A MRI-study detected an edema of the spinal cord at T8. Myelography and spinal Angiography revealed a spinal vascular malformation at the same level. Both lesion were removed and the histological examination confirmed the coexistence of an intramedullary spinal metastasis from a carcinoma of the bronchus with a spinal vascular malformation.

Carcinoma, Squamous Cell↗
PubMed1996

[Percutaneous puncture tracheostomy in neurosurgical intensive care patients].

In critical care patients requiring prolonged mechanical ventilation, tracheostomy is necessary. Alternatively to the standard surgical method, a percutaneous dilatational technique is available. From September 1993 to October 1994 38 critically ill neurosurgical patients underwent tracheostomy using the minimal invasive puncture method. The patients were aged between 20 and 92 years. The average duration of the tracheostomy was 7.5 [4-15] minutes and was performed bed sided at the ICU. The tracheostomy was controlled endoscopically through the naso- or orotracheal tube. A 8 mm cannula was inserted in each case. One patient died during the procedure of sudden fulminant pulmonary artery embolism. One procedure had to be interrupted because of cardiac failure. In this patient the tracheostomy was performed the day after under optimized conditions. There was no peri- or postoperative bleeding, no pneumothorax, no misplacement of the cannula. An infection of the stoma site was not noticed. The decannulation did not cause any complications (16 cases). The stoma was closed within a few days, only a small scar remained. The bed side procedure of percutaneous dilatational tracheostomy is a safe and quick technique. There is no need to disconnect the patient from intensive monitoring for means of transportation to the surgery room. Thus we find it the method of choice for critically ill neurosurgical patients.

Adult↗
PubMed1995

Long-term follow-up in 233 patients with congenital hydrocephalus.

Data on 233 children with congenital hydrocephalus who were operated on in our department from 1964 to 1984 were analyzed. The study was started in January 1990 and was based on questionnaire followed by a psychological examination. Thirty-two patients (13.7%) died during the follow-up period. The average number of operations during the observation period was 2.7; in 166 patients (= 71.2%) the shunt had to be revised at least once. The reason for revision was a mechanical problem in 79.4% and infection in 15.5%. The psychological evaluation in 115 patients showed a normal performance in 62.8%, while 29.8% had mild retardation, evident in speech impairment and/or impaired speech development, in memory and concentration, in poor intellectual performance and decreased performance in school. Severe retardation was seen in 7.4% of cases. Our results showed that the best outcome can be achieved with early shunt implantation. We did not, however, find any correlation between shunt revision rate and psychological results.

Achievement↗
PubMed1993

Magnetic stimulation for monitoring of motor pathways in spinal procedures.

Transcranial magnetic stimulation was used for intraoperative motor evoked potential monitoring during surgery of intramedullar, extramedullar, and extradural spinal tumors in 13 patients. Anesthesia was based on etomidate. Magnetic stimulation for motor evoked potential monitoring was successful in 10 of 13 patients, 12 of whom were neurologically impaired. Motor evoked potentials were recorded from limb muscles or from the fibers of the cauda equina. Amplitudes of baseline recordings (the initial recording obtained after induction of anesthesia) were decreased by 64 +/- 34% (mean +/- SD) and baseline latencies were increased by 7 +/- 8% compared with the preoperative recordings. Subsequent recordings were analyzed for amplitude and latency changes in comparison to baseline. Amplitude changes exceeding 50% and latency changes higher than 3 ms compared with the baseline correctly indicated an impending lesion of motor pathways with increased paresis postoperatively. In cases where motor evoked potential monitoring was successful prediction of short-term postoperative motor outcome was always correct. There were no "false-negatives" or "false-positives."

Adult↗
PubMed1992

Immunotherapy with stimulated autologous lymphocytes in a case of a juvenile anaplastic glioma.

The effect of immunotherapy with stimulated autologous lymphocytes (SAL) in malignant gliomas is documented and discussed in a bioptical and autoptical case study. A five-year-old child with a recurrently operated and radiated right hemispheric anaplastic astrocytoma died six weeks after immunotherapy with mitogen-activated killer cells and recombinant Interleukin-2. The autopsy revealed a large butterfly glioma with partially necrotic gelatinous tissue at the site of the SAL reservoir. The tumor cell density on the right was less than on the left hemisphere, and T-lymphocyte content was higher on the right hemisphere. These results demonstrate a local effect of SAL therapy in vivo, although the tumor progression as a whole could not be stopped. They also demonstrate the need of a detailed neuropathological examination in all cases of immunotherapy of malignant gliomas.

Brain Neoplasms↗
PubMed1991

Conduction velocities of pyramidal tract fibres and lumbar motor nerve roots: normal values.

Measurements of spinal cord and individual lumbar nerve root lengths were performed in 20 dissected cadavers. These data were correlated with the pyramidal tract and motor root conduction times obtained in 53 healthy subjects using motor evoked potentials. The distance between motor cortex and the level of the anterior horn cells ranged from 50.2 +/- 3.0 cm (mean +/- standard deviation) for the L1 segment to 54.4 +/- 3.6 cm for the L5 segment. The length of the motor roots from their exit from the myelon to their exit from the intervertebral foramen ranged from 10.3 +/- 1.7 cm in the L1 root to 17.5 +/- 1.9 cm in the L5 root. The central motor conduction velocity calculated for the distance motor cortex - anterior horn cells of the L5 segment was 50.1 +/- 4.5 m/s. The proximal peripheral conduction velocity of the motor nerve root between its exit from the spinal cord and its exit from the intervertebral foramen was 75.9 +/- 29.0 m/s. The overall conduction velocities between motor cortex and exit of the nerve roots from the intervertebral foramen were 57.4 +/- 6.3 m/s for the L4 fibers to the quadriceps femoris and 57.3 +/- 6.1 m/s for the L5 fibers to the anterior tibial muscle.

Adult↗
PubMed1991

[MRT in syringomyelia--follow-up control after syringo-arachnoid shunt surgery with clinical correlation].

In 8 patients with syringomyelia, MR long-term follow-ups (observation period 25-46 months) were done after syringosubarachnoidal shunt operations. MR showed directly after surgery in 6 cases an extensive collapse of the syringomyelias and in 2 cases a lesser reduction of the diameter of the syrinx. During the subsequent course the size of the cavities increased again in 3 cases. The size of the syrinx visualised by MR did not correlate with the clinical status during the follow-up studies. This seems to point to an insufficient representation of the disease process by the morphological visualisation of the size of the syrinx.

Adult↗
PubMed1991

[Intraoperative monitoring with evoked potentials in spinal interventions].

This review article delineates the physiology and methodological principles of somatosensory (SEP) and motor evoked potentials (MEP), as well as our own results in 40 patients monitored during spinal surgery. In 29 patients an intraoperative SEP and in 15 patients a MEP monitoring was performed. Both modalities were applied in 4 patients. 19 patients had an intramedullary tumor, 15 patients had an intradural extramedullary tumor, 4 patients had an extradural mass lesion, and 2 patients had a spinal arteriovenous malformation. Technical problems with SEP monitoring occurred in 3 of 29 cases, problems with MEP monitoring occurred in 4 of 15 cases. Whereas anesthesia showed only little influence on SEP, an appropriate anesthesiological management was of major importance for MEP monitoring. Other factors, e.g. body temperature and blood pressure, also affected the evoked potentials. In all 35 patients in whom intraoperative SEP and/or MEP monitoring was successfully performed, evoked potentials showed a clear correlation with the initial postoperative neurological findings i.e. there were only cases of correct positive or correct negative monitoring. Transient evoked potential changes could always be attributed to surgical maneuvers. Our results show that intraoperative spinal cord monitoring with both SEP and MEP can supply helpful information on neural integrity. The choice of the evoked potential modality to be used and the choice of the sites of stimulation and recording depends on individual pathoanatomical findings and on the operative procedure required. Intraoperative evoked potential monitoring is indispensable during high risk spinal surgery such as surgery for intramedullary tumor or for mass lesions above C5.

Afferent Pathways↗