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Biomedical subjects

C Probst

Publications and source records attributed to C Probst.

At least 19 recordsLinked to original sources
PubMed1992

[Heart arrest in excision of large craniopharyngiomas: two cases with successful resuscitation--pathogenic considerations].

A reversible cardiac arrest with successful resuscitation/cardiac massage occurred in two female patients in the context of the relatively radical extirpation of large mainly solid craniopharyngiomas with supraretrosellar and retrochiasmatic extension. Clinical (including ECG) and pathological anatomical investigations (especially after subarachnoid hemorrhages) and the results of animal experiments indicate that the cardiac arrest was caused by an acute functional disturbance in the dorsocaudal hypothalamus. In particular, the coincidence of hemorrhages/ischemia in the hypothalamus and subendocardially as well as the pronounced elevation of catecholamines observed by some authors is noteworthy.

Adult↗
PubMed1991

[Neurosurgery in old age. II: CNS tumors--cerebrospinal-vascular diseases--pain surgery--conclusions].

The relative percentage of patients who are admitted to our clinic with benign tumours often susceptible to therapy has increased from 23% (1974) to 55% (1989). In patients over 60 years old, these are above all cranial tumours (most frequently meningiomas), whereas metastases predominate at the spinal cord. 8% of the cranial meningiomas show an apoplectiform course (mostly steal effects). On the other hand, very large cranial meningiomas causing few symptoms are particularly frequent in elderly patients (larger reserve space, reduced tendency to edema). The use of minimally damaging surgical approaches, palliative operations and possibly a cautious radicality adapted to location and extent are especially important for tumour surgery in elderly patients, especially for tumours with a low tendency to proliferate. Our own experience in vascular pathology concern arteriovenous aneurysms and the diagnosis/therapy of spontaneous intracerebral hemorrhage and space-occupying malacia in the region of the cerebrum and the cerebellum. Epidural hematomas and the spinal dural arteriovenous fistulae which often become manifest at an advanced age owing to increasing medullary venous stasis are of particular therapeutic importance in elderly patients. Depending on the situation, direct surgical elimination or treatment by selective embolization may be considered. Typical trigeminal neuralgia is especially frequent in patients over 60 years in neurosurgical treatment of very severe therapy-resistant pain. Whereas the microvascular decompression of the trigeminal roots near the pons (compression by arterial loops) is most important in younger patients, we use the minimally invasive, relatively simple percutaneous thermo-rhizotomy in the Gasserian ganglion with selective functional elimination of the thinner pain fibers in elderly patients. Ablative measures are otherwise possible, above all in nociceptive pain, whereas the stimulation of the lemniscal system is of primary significance in deafferentation pain (e.g. causalgia). Spinal stimulation in inoperable peripheral arterial occlusive disease (leg, pelvis) to improve the microcirculation is of special importance: The prospect of success is greater than 80% in Fontain stage III. We do not apply subarachnoid spinal morphine administration only in malignancies, in contrast to intraventricular morphine administration (right anterior horn). For elderly patients with very severe inoperable lumbar stenosis (mostly spondylarthritis), the dosage-controlled continuous low-dose subarachnoid administration of morphine via a subcutaneously implanted programmable pump with a reservoir is suitable in some cases. These examples show that neurosurgery may be appropriate even in elderly patients. Today, more differentiated and at the same time minimally invasive diagnostic and surgical methods are available.

Aged↗
PubMed1991

[Neurosurgery in old age. I: Significance of the problem--herniated disk, spinal canal stenosis--craniocerebral injuries--chronic subdural hematoma--resorptive hydrocephalus].

The relative percentage of patients over 60 years who underwent operations in our clinic has greatly increased from 18% in 1874 to 27% in 1989. Postoperatively, difficulties may also result from additional medical problems, which may be cardiovascular, pulmonary, metabolic (especially diabetes mellitus), increased thromboembolism in origin as well as from the reduced tendency to neurological recovery in elderly patients. On the other hand, advances in diagnostics and surgical treatment often make it possible to help even these patients effectively today. The clinical pictures which are especially frequent in our hospital are specified below. Disc herniations: Soft nucleus-pulposus herniations occur in every age group. In elderly patients, the osseous constriction of the lumbar canal (especially by spondylarthrosis) often leads to spinal claudication. Functional myelography with myelograms taken in the sitting and the standing position is important for preoperative appraisal. On the basis of the clinical/neuroradiological findings, it may be decided whether a selective or an extended decompression is necessary. Larger-scale decompressions are mostly possible in this age group without postoperative instability, with good results in more than 80% of the cases. In our clinic, anterior microsurgical decompression without graft is the most frequently used procedure in cervical disc herniations/spondylosis, a method which is well tolerated by spinal cord and nerve roots: 75% simple anterior discectomies/spondylectomies compared to only 25% classical Cloward operations with bone grafts. We use intervertebral bone grafts only in severe spondylosis and/or instabilities, if necessary in combination with metal plates (e.g. in the context of cervical myelopathy). Craniocerebral injuries: Epidural hematomas and CSF fistulae, but also circumscribed space-occupying contusions have a relatively favorable prognosis in every age group. The older the patient, the more serious is the acute subdural hematoma, which is often associated with extensive contusions, although surprisingly good recoveries are occasionally possible postoperatively even here. Detailed scrutiny of all prognostically relevant factors is important. In borderline situations we give the patient a chance in order to take later action, depending on the course. Chronic subdural hematomas are especially frequent and readily dealt with surgically in patients over 60 years. The simple borehole drainage to the outside is often sufficient. In extensive excreting membranes, which are especially frequent in elderly patients, we prefer today a subdural-peritoneal drainage for six to eight weeks to the very much more burdensome craniotomy: The relatively simple operation allows an early mobilization and almost always a prompt healing. Hydrocephalus male resorptivus is also very much more frequent in this age group.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1991

[Demand-controlled continuous spinal-cerebral morphine administration via an implanted programmable pump].

The significance of the demand-controlled spinal and cerebral administration of morphine has increased with the improvements in the variable techniques (including programmable implanted pumps). Continuous low-dose infusion enables sustained pain-free state with minimal risks and side effects, so that this method is also feasible for treatment of very severe therapy-resistant pain in benign conditions. Neurostimulation of the lemniscal system (dorsal columns of the spinal cord, specific thalamus, etc., especially in deafferentation pain) and surgical interruption of pain pathways and centers (especially in nociceptive pain) as a last resort continue to be indispensable. In our view, the assumption that spinal and cerebral application of morphine is not appropriate in deafferentation pain is not justified on the basis of the most recent discussions and our own observations. Merely higher doses are probably required for this type of pain.

Adult↗
PubMed1991

[The value of computerized tomography for neurosurgical treatment of traumatic frontobasal cerebrospinal fluid fistulas. 300 cases].

300 patients with traumatic frontobasal CSF-fistulae were treated neurosurgically from 1967 to 1989. CT was introduced in 1980, allowing a definitive detection of intracranial lesions including appraisal of cerebral edema, direct detection of fistulae (metrizamide-CT) and of brain hernias and far better imaging of osseous lesions, also of fine structures, such as a better apprasial of paranasal sinus pathology. Classical radiology is, however, still indispensable for imaging certain fracture types and localization of a pneumocranium. Computer Tomography allows an improvement of postoperative results, influencing indication, timing of operation, such as surgical approach.

Brain Injuries↗
PubMed1990

[Rehabilitation after surgical therapy of herniated disk].

The author discusses his experience in 5000 lumbar disk hernias and 400 cervical disk hernias submitted to microsurgery. The surgical technique is described only in so far as is necessary for postoperative care and results. In addition to immediate postoperative treatment, subsequent rehabilitation and reintegration are of special interest. Finally, some alternative methods are briefly discussed.

Cervical Vertebrae↗
PubMed1990

[The current significance of spinal cord stimulation in the framework of functional neurosurgery].

Spinal cord stimulation (DCS) has proved effective in different types of Deafferentation Pain. Long-term results are good in 60-85% of cases. DCS improves microcirculation and ischemia in cases of inoperable peripheral vascular diseases. Advantages of this method are: Absence of severe complications and estimation of the effect during the test phase. - Nevertheless, other neurosurgical possibilities (destructive pain surgery, spinal/cerebral application of medicaments) continue to preserve their indications.

Cordotomy↗
PubMed1990

[Incidence and characteristics of lumbar disk hernias in older patients].

Previous history, clinical findings, course and therapeutic outcome in 149 elderly patients with lumbar disk hernia were analyzed and compared with younger adult patients. 21% of all patients with lumbar disk hernia undergoing surgical treatment, and 25% under conservative treatment, were aged over 60 years. In these patients no history of low back pain is present in one third, the course is prolonged and motor deficits are more often encountered. Concomitant osseous narrowing (spinal stenosis, narrowed recessus lateralis) were present in 72% of this elderly group. Surgical complications are increased (34%) and are due to age-related diseases. Functional results are excellent after both conservative treatment and surgical therapy.

Adolescent↗
PubMed1990

Microsurgical cordotomy in 20 patients with epi-/intradural fibrosis following operation for lumbar disc herniation.

Using an improved microsurgical technique, cordotomy was carried out by the cervicothoracic route in 20 patients with persistent radicular pain due to epi-/intradural fibrosis following operation for lumbar disc herniation. 65% of them had good long-term results with respect to radicular pain (follow-up period 6-132 months; mean 66 months). Permanent severe motor impairment was not observed. In patients with severe pain of benign organic origin microsurgical cordotomy can be considered as a "last resort".

Adult↗
PubMed1990

Spinal cord stimulation in 112 patients with epi-/intradural fibrosis following operation for lumbar disc herniation.

A total of 112 patients with epi-/intradural fibrosis following operation for lumbar disc herniation were treated by spinal cord stimulation. Lumbosacral spinal fibrosis is seen particularly often after extensive and repeated operations. Radicular pain responds better to stimulation than back pain. A favourable long-term effect on radicular pain has been observed in 67% of patients treated by epidural implantation, the corresponding average follow-up period being 4 1/2 years. 40% of these patients needed less analgesics after the operation, while 25% of them showed an improved fitness for work. Among about 5,000 patients who underwent surgical treatment for lumbar disc herniation, an indication for spinal cord stimulation was found in 1.5%. By comparison, the frequency of the "last resort" procedure of microsurgical cordotomy was 0.3%. We no longer use other ablative methods like extirpation of spinal ganglia.

Analgesia, Epidural↗
PubMed1990

Neurosurgical treatment of traumatic frontobasal CSF fistulae in 300 patients (1967-1989).

300 patients with traumatic fronto-basal CSF fistulae were treated neurosurgically from 1967 to 1989, i.e. via a transcranial approach. An additional intracranial space occupying lesion, a direct open endocranium and/or a large basal brain hernia was found in 68%. The following aspects were discussed: progress in establishing the exact anatomical diagnosis, especially neuroradiological advances; questions of the indication for surgery; the problem of the optimal surgical approach. Both the cranial and the rhinological approach have advantages and disadvantages. Their indications only partly coincide, so that the choice of method depends especially on the individual pathology. Advances were made in recent years in terms of neurosurgery as well as of rhinology. The neurosurgical results could be improved, and postoperative complications have become rare after the cranial approach. Besides the optimal choice of the time of operation, the following factors are important: an adequate intracranial debridement; a microsurgical technique entailing as little damage to surrounding tissue as possible and various specially mentioned brain-protective measures. An optimal collaboration between the specialties involved is the basis for further progress. More attention must be paid to endocrinological problems in the future.

Adolescent↗
PubMed1990

[The neurosurgical treatment of traumatic fronto-basal spinal fluid fistulas. 66 cases (1982-1986)].

Between 1982 and 1986, 66 patients suffering from traumatic frontobasal CSF fistulas were treated neurosurgically i.e. via a transcranial approach. In 68% an additional transcranial space-occupying lesion a direct open endocranium and/or a large basal cerebral hernia were found. The cases and relevant findings are discussed, followed by deliberations on the points enumerated below: --diagnostic, especially neuroradiological advances --problems of indications for surgery --the problem of the best possible surgical approach Both cranial and rhinological approach have their pros and cons. Their indications agree only partly, so that the choice of the method depends especially on the individual pathology. Progress has been achieved in recent years both neurosurgically and rhinologically. Neurosurgical results have been improved upon, and postoperative complications after cranial approach are now rare. Essential factors, apart from selecting the best possible time for surgery, are: --adequate intracranial debridement --the use of a microsurgical technique, as well as application of a various brain-protective, measures as stated in this article. Further progress is fundamentally based on best possible mutual cooperation between the disciplines involved, paying increased attention in future to endocrinological problems.

Adolescent↗
PubMed1989

[Ventral operations in cervical disk hernia. Neurosurgical experiences in 400 surgical patients].

The indications for simple ventral discectomy as well as for the classical Cloward's operation, together with the surgical techniques employed and the results obtained, are compared in a group of 400 patients treated operatively for cervical disc hernia. The ventral approach is sparing for both the spinal cord and the nerve roots and gives satisfactory results from the point of view of stability. In more than one-half of the patients, luxated fragments of the nucleus pulposus were found epidurally, so that fairly frequent exploration of the epidural space was necessary. Simple microsurgical discectomy (performed in a total of 158 cases) is now more often used than the classical Cloward's operation (242 cases). In 1987 we carried out simple discectomy in 75% of cases. Cloward's operation with extirpation and bone grafting is, however, advantageous in patients with severe spondylosis as well as in cases of traumatic or degenerative instability.

Adult↗
PubMed1989

[Lumbar disk hernia: microsurgery--yes or no?].

Microsurgery has been performed in about three-quarters of 5,000 patients operated on since 1973 for herniation of a lumbar disc. The findings obtained in two groups of patients who had undergone primary surgery, in the one group by classical methods, in the other by microsurgery, are compared. The two groups were similar in respect of age and sex distribution, localisation of the discal hernia, duration of signs and symptoms and follow-up time. Results classified "very good" were seen more often in the microsurgery group, where no improvement or postoperative aggravation of the signs was relatively rare. The difference compared with the group treated by conventional surgery was mainly in respect of appearance of a postoperative vertebral syndrome, and not so much with regard to the radicular pain syndrome and radicular motor deficits. Unlike some other researchers, we found no difference between the two groups in respect of frequency of local reoperation or of spondylodiscitis. In patients whose disc hernia is mainly of a soft consistency, unilateral and at a single level only, microsurgery requires a shorter access, involves less damage to tissues, allows a better haemostasis and good surgical visualisation. The operation is minimally invasive, the area involved more or less extensive depending on the individual pathology. Magnification under good lighting is indicated in all cases.

Adult↗