PubMed Health⌕ Search

Biomedical subjects

C Cedzich

Publications and source records attributed to C Cedzich.

At least 19 recordsLinked to original sources
PubMed2005

Neurological and psychosocial outcome after subarachnoid haemorrhage, and the hunt and hess scale as a predictor of clinical outcome.

In a retrospective study, the outcome of 87 patients with ruptured intracranial aneurysm was assessed. Follow-up included neurological examination, grading of the Glasgow Outcome Scale (GOS) of each patient, and answering a psycho-social questionnaire. This questionnaire was answered by the patients themselves or by a relative when the patient was not able to answer. The follow-up was performed more than 12 months after the occurrence of subarachnoid hemorrhage (SAH) in each patient. The psycho-social questionnaire pertained to the degree of independence in everyday activities, household management, stress endurance, memory and concentration, social and leisure activities, social contacts, occupational status, and marital relationships. By summarizing the results of these domains, the quality of life was then determined using the method described by McKenna et al. Neurological deficits in the form of an incomplete paresis of the third cranial nerve and subjective reduction of memory and concentration were identified in 3.5 % and 34.5-39 % of the patients, respectively. Of the 87 study participants, 58.2 % were fully independent, 22.4 % were able to live at home with the support of their relatives, and 5 patients were fully dependent. The occupational status of 21 patients who were fully employed before SAH was unaffected, whereas 3 patients were placed in positions with less responsibility, and 21 patients were either unable to continue working, unemployed, or retired. The quality of life was not reduced in 57.2 %, while a mild reduction in the quality of life was reported by 23.8 % and a severe reduction by 19.0 % of the participants. The ability of the initial Hunt and Hess grade, the initial Fisher grade, the extent of neurological deficits, and the occupational status after SAH to predict the patient's outcome was also evaluated. For statistical analysis, the Kendall-Tau-b-test for non-parametric correlations was applied. Significant correlations were found between the initial Hunt and Hess grade and the initial Fisher grade, between neurological deficits and GOS, between quality of life and occupational outcome, as well as between the GOS and quality of life assessment, but not between initial Hunt and Hess grade and GOS or quality of life, between neurological deficits and quality of life, between initial Hunt and Hess grade and occupational outcome, between initial Fisher grade and occupational outcome, and also not between initial Fisher grade and GOS or quality of life. Our results suggest that neither the initial Hunt & Hess grade nor the initial Fisher grade are suitable parameters for predicting the outcome of patients with ruptured intracranial aneurysms. The fact that GOS and quality of life correlated significantly confirms the use of GOS as a simple method for evaluating patient outcome, although it is not a grading system for evaluating functional disorders such as memory or subtle cognitive impairments.

Adult↗
PubMed2003

[Diagnosis and therapy of syndromic and non-syndromic craniosynostosis].

Premature craniosynostosis is caused by a premature closure of single or multiple sutures of the cranial vault. It may result not only in aesthetic but also in functional disorders with an occasional ICP increase leading to a dramatic loss of vision. In the 1970s,Paul Tessier published his craniofacial principles for the primary treatment of craniosynostosis. His approach has gained wide acceptance over the previously described craniectomies and bone flaps, especially because of the significant benefits with an acceptably low level of morbidity. The following paper reviews the different kinds of craniosynostoses, their specific clinical manifestations, the necessary diagnostic examinations and the specific surgical procedures and operative results.

Child, Preschool↗
PubMed2003

[The treatment of hydrocephalus in infants and children using hydrostatic valves].

Complications of CSF-shunt systems may not only prolong hospitalization, but also influence dramatically the neurological and mental outcome of patients, especially of premature newborns. Shunt complications may be caused by mechanical problems such as shunt occlusion or dysfunction of the valve itself. Another cause of shunt complications is the overdrainage and, lastly, shunt infection. The choice of the specific shunt system seems to play an important role in avoiding the above mentioned complications. In this study 32 children with hydrocephali due to different etiologies were treated with hydrostatic valves, the so called Pädi GAV (pediatric hydrostatic valve) valves developed by Miethke. In addition to mechanical occlusions and shunt infections, the overdrainage related complications, such as subdural hematomas/ fluid collections, slit ventricles and secondary craniosynostoses were taken into consideration. None of the patients showed these complications. On the contrary, postoperative MRI or the ultrasound demonstrated prominent ventricles comparing these with those of non-hydrocephalic children as measured by the Evans-Index and FOR (fronto-to-occipital ratio). Whether the overdrainage-related complications actually reduced using Pädi GAV valves will be shown by further long-term follow ups. This study aims to evaluate the initial experience with the Pädi GAV shunt system, particularly with respect to the overdrainage-related problems.

Cerebrospinal Fluid Shunts↗
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↗
PubMed1999

Minimally invasive stereotactically-guided extirpation of brain stem cavernoma with the aid of electrophysiological methods.

The surgical extirpation of brain stem cavernomas always includes a risk of neurological deficits. To minimize the risk of deficits and control the motor and sensory function intraoperative monitoring of SEP and MEP seems to be helpful. The high density of motor and sensory fibers within the brain stem makes bilateral intraoperative monitoring necessary. The following case demonstrates a stereotactically-guided supratentorial, transventricular approach for extirpation of a brain stem cavernoma. Sensory and motoric functions were observed by transcranial recording of SEP's and by transcranial stimulation of motor cortex.

Adult↗
PubMed1998

Electrophysiological considerations regarding electrical stimulation of motor cortex and brain stem in humans.

OBJECTIVE: To provide information about activation of descending motor pathways in humans, motor evoked potentials were obtained from 16 patients without any sensorimotor deficit, after both cortical and brain stem stimulation. METHOD: Total anesthesia was achieved in all patients through intravenous administration. Short trains of one to five electrical pulses were delivered separately to the motor cortex and the brain stem. Compound muscle action potentials were recorded from the contralateral upper extremity. Threshold intensity, stimulus polarity, latencies, and effect of increased stimulus intensity on latencies were analyzed. RESULTS: The threshold intensity was significantly lower when stimulating the brain stem than when stimulating the cortex. A monophasic anodal stimulus was better for cortical stimulation than for brain stem stimulation. Conversely, a monophasic cathodal stimulus was more effective for brain stem stimulation. The rate of unsuccessful stimulations was higher with brain stem stimulation and with increased stimulation intensity. The variability of latencies was so high that a calculation of the conduction velocity of the motor pathways was not possible. CONCLUSION: The results indicate that cortical surface and brain stem stimulation act on different nervous elements. Because of the condensation of motor pathway fibers at the brain stem level, much less stimulus intensity for eliciting compound muscle action potentials was necessary. On the other hand, the higher rate of unsuccessful brain stem stimulations may be caused by a block of conduction at either the anterior horn cell pool or the neuromuscular junction. Thus, for cortical and for brain stem stimulation, different stimulating parameters seemed to be necessary with the patient under general anesthesia.

Action Potentials↗
PubMed1996

Somatosensory evoked potential phase reversal and direct motor cortex stimulation during surgery in and around the central region.

In 99 patients with mass lesions in and around the central region, the central sulcus was intraoperatively localized with the use of somatosensory evoked potential (SEP) phase reversal. In 33 of these patients, the motor cortex was directly stimulated and electromyographic responses were recorded from the forearm flexor, thenar, and hypothenar muscles. An additional 25 patients, with subcortical lesions or lesions directly located at the pyramidal tract, were continuously monitored during surgery by motor evoked potentials (MEPs). An exact determination of the central sulcus and tumor localization was possible in all patients; a phase reversal was obtained in 90.8% of the patients, and localization was possible as a result of anatomic structures and the loss of N20 or P20 of SEPs in the other 9.2%. MEPs were obtained in 32 of 33 patients and also in all 25 patients who underwent MEP monitoring at the beginning of tumor removal. From this study, it can be concluded that the combination of SEP phase reversal and modified electrical cortex stimulation is compatible with general anesthesia, although anesthesia was not systematically controlled according to a protocol. Although this study demonstrates that the combined SEP/MEP technique was feasible, it is not yet possible to demonstrate benefit in improving the outcome of patients. Concerning the safety of stimulation, the exact localization of the central sulcus by the noninvasive SEP method, compared with direct electrical stimulation, offered more safety for the patient. The modified technique of direct motor cortex stimulation needed much less charge density than did the common technique. The recording of electromyographic responses instead of movements made objective documentation possible, and the analysis of amplitudes and latencies will supply quantitative information about the motor system.

Adolescent↗
PubMed1996

Transcranial high-frequency repetitive electrical stimulation for recording myogenic motor evoked potentials with the patient under general anesthesia.

OBJECTIVE: To demonstrate the feasibility of transcranial high-frequency electrical stimulation with the patient under general anesthesia with propofol and alfentanil. This method may be a useful tool for intraoperative monitoring of the motor pathways during cerebral and spinal operations. METHODS: A short train from one to eight monopolar anodal electrical pulses was applied transcranially to the motor cortex with a frequency from 100 to 500 Hz in 10 patients. Myogenic motor evoked potentials (MEPs) were recorded from forearm flexor muscles, thenar, and hypothenar. Amplitude and latency of MEPs were evaluated after different stimulation parameters. This combination of anesthetic and transcranial stimulation technique allows recording of myogenic MEPs during general anesthesia, which was found not to be possible with single pulse transcranial stimulation. RESULTS: To elicit myogenic MEPs from the target muscles, stimulation had to be applied within the following parameters: minimum threshold intensity was 60 mA for forearm flexor and thenar and 80 mA for hypothenar; minimum number of pulses was two for forearm flexor muscles and thenar and three for hypothenar; minimum stimulation frequency was 200 Hz for thenar and hypothenar and 100 Hz for forearm flexor muscles. CONCLUSION: Transcranial high-frequency repetitive electrical stimulation seems to be a new method for monitoring the motor tract. With this method, it is possible to monitor the motor function without interfering with the surgical team or with the surgical treatment of infratentorial and spinal lesions. Monitoring of relaxation is necessary to compare the amplitude of MEPs.

Adolescent↗
PubMed1995

Posterior inferior cerebellar artery aneurysm in the fourth ventricle.

We report a patient with a ruptured aneurysm of the choroidal branch of the right posterior inferior cerebellar artery (PICA), lying in and causing an isolated haemorrhage in the fourth ventricle. MRI on the first day after bleeding revealed an abnormal vessel in the fourth ventricle, which was surrounded by a mass of intermediate signal on T1- and T2-weighted images. The aneurysm was clipped via partial splitting of the lower vermis and opening the inferior medullary velum. A postoperative angiogram confirmed complete obliteration of the aneurysm. With PICA aneurysms the rate of intraventricular haemorrhage is high and in most cases due to reflux of blood. If there is an isolated intraventricular haemorrhage, a peripheral PICA aneurysm, lying in or near the fourth ventricle, may be suspected.

Cerebellum↗
PubMed1993

Lethal septicemia caused by calcified cavo-tricuspid thrombus. Case report on a patient with atrial shunt.

With the introduction of one way calibrated shunt systems, made of silicon rubber, an efficient treatment of hydrocephalus seemed to be possible. The mortality rate decreased rapidly for example for non-communicating hydrocephalus from 80 to 20%. However, other complications appeared, such as shunt infections, shunt malfunctions and even severe thromboembolic complications and septic shock. This report presents one patient with shunt-treated normal pressure hydrocephalus who developed pulmonary emboli, mural calcified atrial thrombus with involvement of the tricuspid valve and shunt infection with lethal septic shock. Despite of an aggressive treatment, he died of multiple organ system failure.

Adult↗
PubMed1993

Outcome and management of intraoperative aneurysm rupture.

The incidence of intraoperative aneurysm rupture (IAR) was studied in a consecutive personal series of 222 patients operated on for a ruptured intracranial aneurysm. In 77 patients subjected to early surgery (operation within 72 h after rupture) IAR was 40.2% and in 145 patients with surgery after 72 h IAR was 20.7%. The mortality and severe morbidity (GOS grade 4 and 5) were 2.6% in the early surgery group, 7.6% in the late surgery group, and 5.85% in the total series despite the fact that there was a significantly higher incidence of IAR in the early surgery group. Aneurysms arising from the anterior cerebral artery (ACA) or anterior communicating artery (ACoA) appeared more prone to IAR--36.9 versus 18.6 and 23.2%--than aneurysms at other locations. There was no correlation between incidence of IAR and preoperative Hunt and Hess grade [8]. IAR affected final outcome only when it occurred prematurely during introduction of anesthesia or during opening of the dura. In conclusion, although IAR occurs more frequently when surgery is undertaken in the early stage after rupture, this complication is in experienced hands not necessarily associated with an increased risk for an unfavorable outcome.

Aneurysm, Ruptured↗
PubMed1993

Modification of cortical stimulation for motor evoked potentials under general anesthesia: technical description.

This pilot study presents a possible modification of direct cortical electrical stimulation technique for the recording of motor evoked potentials under general anesthesia. The exposed primary motor cortex was stimulated by a short train of anodal rectangular pulses at high frequency (300-500 Hz), while the compound muscle action potentials were recorded from the forearm and hand muscles. When compared with the traditional way of eliciting movement of the extremities by applying a train of pulses at lower frequency (50-60 Hz), muscle responses were obtainable at an intensity of much lower charge. It is suggested that this stimulation achieves a repetitive activation of the corticomotoneuronal tract. Responses could be continuously recorded throughout surgery and seemed to respond to surgical manipulation affecting the motor pathways. This technique seems to be applicable for intraoperative monitoring of motor pathways but requires further optimization of stimulation and recording parameters before wider clinical applications are possible.

Anesthesia, General↗
PubMed1993

Isolated parts of the ventricular system.

It has been known for years that patients with shunted hydrocephalus can develop an isolated fourth ventricle with or without signs of cerebellar dysfunction. It has also been reported about other isolated parts of the ventricular system following treatment of communicating hydrocephalus. We observed three children, two with an isolated fourth ventricle and one with an isolated third ventricle. The clinical appearance, the pathogenesis and treatment will be discussed.

Astrocytoma↗
PubMed1992

Pre- and post-operative hydrocephalus in supratentorial intraventricular tumours.

Post-operative problems of hydrocephalus which occur in a high percentage of intraventricular tumours are infrequently discussed. Our experience, however, showed many problems in the treatment of hydrocephalus associated with supratentorial intraventricular tumours. In a series of 40 supratentorial intraventricular tumours different types of management were used and reviewed retrospectively. It is concluded that certain types of management are disadvantageous, like primary shunt insertion. As a result the recommended form of treatment is: primary temporary external CSF-drainage followed by tumour surgery. Post-operative assessment of ventricular compartments and tolerance of drainage withdrawal. Shunt insertion only if compartmentilization or drainage dependency were manifest.

Cerebral Ventricle Neoplasms↗
PubMed1990

Reversible visual loss after shunt malfunction.

Report on three hydrocephalic, shunt dependent children, who became blind due to shunt malfunction and rapidly decreased intracranial pressure. They regained vision several days (one case) or several months (2 cases) after shunt revision. The related literature is reviewed and possible pathophysiological mechanisms are discussed.

Adolescent↗