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Biomedical subjects

C Walch

Publications and source records attributed to C Walch.

At least 19 recordsLinked to original sources
PubMed2005

Combined endoscopic surgery and radiosurgery as treatment modality for olfactory neuroblastoma (esthesioneuroblastoma).

OBJECT: Treatment of esthesioneuroblastoma (olfactory neuroblastoma) has been considerably improved by microsurgical techniques. Nevertheless, these rare tumours of the frontal skull base are still associated with high rates of tumour recurrence and mortality, thus remaining a challenge even for experienced surgeons. A novel therapeutic approach that combines endoscopic sinus surgery and Gamma Knife radiosurgery is presented here. Taking into account the rarity of the disease the present study comprises a relatively large series of patients treated in a similar manner. METHODS: 14 patients (8 males, 6 females) aged 27-75 years (median 38) were treated between May 1993 and December 2003. This series comprises 12 newly diagnosed esthesioneuroblastomas. Two more patients had already previously undergone surgery (24/39 months earlier). Paranasal and nasal endoscopic sinus surgery was performed. Marginal irradiation doses ranging from 15-34 Gy were given to the residual tumours by means of radiosurgery (Gamma Knife) involving 1-7 isocentres within 3 months after surgery. Median follow-up is 58 months (range 13-128). RESULTS: There was no mortality. In all patients tumour control was achieved within the treated area. 4 patients underwent a second radiosurgical procedure 6-79 months (median 34 months) after initial radiosurgery. One patients had to undergo an additional craniotomy because of extensive neoplastic infiltration, 1 developed postoperative liquorrhea, 1 case was complicated by bilateral frontal sinusitis. All patients complained of nasal discharge and crusts. Karnovsky Index--preoperatively ranging from 80%-100%--remained stable in 12 patients, an improvement was observed in 2 cases. CONCLUSIONS: Based on the favourable results recorded so far, the combination of endoscopic sinus surgery and radiosurgery can be considered a promising treatment option for esthesioneuroblastoma that merits further consideration.

Adult↗
PubMed2002

Cranial nerve preservation after radiosurgery of vestibular schwannomas.

Radiosurgery is a management approach used to treat patients with vestibular schwannomas. The goals are long-term tumour growth control, maintenance of cranial nerve function and prevention of new deficiencies. We sought to determine long-term outcomes measuring the potential benefits against the neurological risks of primary radiosurgery. Gamma Knife radiosurgery was applied as a treatment modality for 289 patients with vestibular schwannomas from April 1992 to April 2002. The long-term results of 100 patients who underwent radiosurgery were evaluated. 60 patients received a primary treatment, 40 other cases presented with previously performed subtotal microsurgical resection or recurrence of disease (12-96 months, median 39). The median treatment volume was 3.4 ccm and the median dose to the tumour margin was 13 Gy. The median patient follow-up time was 76 months (range 60-120 months). Four tumours progressed after primary radiosurgery. Tumour control rate was 96%. Useful hearing (Gardner-Robertson I/II) was preserved in 16 patients (55%). Clinical neurological improvement occurred in 50%. Adverse effects comprised neurological symptoms (incomplete facial palsy) (House-Brackman II/III) in six cases (four recovered completely), mild transient trigeminal neuropathy in five cases, and morphological changes displaying rapid enlargement of preexisting macrocysts in two patients and tumour growth in two other patients. Microsurgical resection was performed in four cases (4%) and two patients underwent a shunting procedure because of hydrocephalus formation (2%). In patients who had undergone previous microsurgery, no new cranial nerve deficit was observed. Radiosurgery is an effective method for growth control of vestibular schwannomas and is associated with both a low mortality rate and a good quality of life. Accordingly, for the preservation of cranial nerve function radiosurgery is a useful method for the management of properly selected patients and is comparable to microsurgery.

Adolescent↗
PubMed2002

Radiosurgery of residual and recurrent vestibular schwannomas.

Radiosurgery is either a primary or an adjunctive management approach used to treat patients with vestibular schwannomas. We sought to determine outcomes measuring the potential benefits against the neurological risks in patients who underwent radiosurgery after previous microsurgical subtotal resection or recurrence of the tumour after total resection. Gamma Knife radiosurgery was applied as an adjunctive treatment modality for 86 patients with vestibular schwannomas from April 1992 to August 2001. We evaluated the results of 50 patients who had a follow-up of at least 3.5 years (median 75 months, range 42-114 months). In 16 patients a recurrence of disease was observed after previous total resection. The median treatment volume was 3.4 ccm with a median dose to the tumour margin of 13 Gy. Tumour control rate was 96%. Two tumours progressed after adjunctive radiosurgery. Useful hearing (Gardner-Robertson II) (4 patients (8%)) and residual hearing (Gardner-Roberson III) (10 patients (20%)) remained unchanged in all patients, who presented with it before radiosurgery, respectively. Clinical neurological improvement was observed in 24 patients (46%). Adverse effects comprised transient neurological symptoms and signs (incomplete facial palsy, House-Brackman II/III) in five cases (recovered completely), mild trigeminal neuropathy in four cases, and morphological changes displaying rapid enlargement of a pre-existing macrocyst in one patient and tumour growth in another one. No permanent new cranial nerve deficit was observed. Radiosurgery appears to be an effective adjunctive method for growth control of vestibular schwannomas and is associated with both a low mortality rate and a good quality of life. Accordingly, radiosurgery is a rewarding therapeutic approach for the preservation of cranial nerve function in the management of patients with vestibular schwannoma in whom prior microsurgical resection failed.

Adolescent↗
PubMed2002

Long term results of radiosurgery for vestibular schwannomas.

UNLABELLED: Radiosurgery is either a primary or an adjunct management approach used to treat patients with vestibular schwannomas. The goals are long-term tumour growth control, maintenance of cranial nerve function and prevention of new neurologic deficiencies. We sought to determine long-term outcomes measuring the potential benefits against the neurological risks of radiosurgery. METHODS: 278 patients with vestibular schwannomas underwent Gamma Knife radiosurgery as a treatment modality for from April 1992 to November 2001. The long-term results of 60 patients were evaluated who received radiosurgery as primary treatment. 12 cases presented with previously performed subtotal microsurgical resection or recurrence of disease (12-96 months, median 39). The median treatment volume was 3.8 ccm and the median dose to the tumour margin was 12 Gy. The median patient follow-up time was 88 months (range 72-114 months). RESULTS: Four tumours progressed after primary radiosurgery. Tumour control rate was 93%. Useful hearing (Gardner-Robertson I/II) was preserved in 16 patients (55%). Clinical neurological improvement occurred in 36 patients (60%). Adverse effects comprised neurological symptoms (incomplete facial palsy) (House-Brackman II/III) in five cases (three recovered completely), mild trigeminal neuropathy in three cases, and morphological changes displaying rapid enlargement of preexisting macrocysts in two patients and tumour growth in two other ones. Microsurgical resection was performed in three cases (5%) and one patient underwent a shunting procedure because of hydrocephalus formation. In patients who had undergone previous microsurgery, neither new cranial nerve deficit nor any tumour growth was observed. CONCLUSIONS: Radiosurgery performed with current techniques proved to be an effective method for growth control of vestibular schwannomas with both a low mortality rate and a good quality of life. An increasing percentage of patients will undergo radiosurgery as accessibility to this alternative increases, and more data regarding long-term follow-up are available. It is a post-operative complementary treatment for partially removed tumours. Accordingly, radiosurgery is a useful method for the management of properly selected patients.

Adolescent↗
PubMed2001

[Mondini dysplasia without functional impairment in the framework of a CHARGE association].

UNLABELLED: A male child with fully developed CHARGE association was referred to our hospital several times because of choanal atresia and suspected hearing loss in his first two years of life. As far as they are a main symptom malformations of the ear appear frequently in CHARGE association. This report describes that an obvious anatomic dysplasia of the inner ear can have normal function, which is shown by objective measurement. METHODS AND RESULTS: Computed tomography of the petrous bone showed bilateral Mondini malformation of the cochlea combined with bulky deformation of middle ear ossicles. By the age of one year brainstem evoked response audiometry (BERA) was performed. The result demonstrated a hearing loss of 60 dB on the right ear, but no measurable hearing loss on the left ear. CONCLUSION: This case report proves that a Mondini-type malformation of the cochlea does not need to be combined with hearing loss.

Abnormalities, Multiple↗
PubMed2001

[Radiosurgery of recurrent acoustic neurinoma or: the elegant solution of a surgical problem?].

BACKGROUND: Stereotactic radiosurgery has proved to be an effective alternative to microsurgical resection in treatment of acoustic neuroma. Still, microsurgery is considered by many to be the therapy of choice. In case of recurrence microsurgical resection is much more difficult because of scarring and has a higher risk of complications. Therefore in cases of recurrence the role of radiosurgery needed to be evaluated. PATIENTS AND METHODS: From April 1992 to July 1997 135 patients suffering from acoustic neuroma were treated at the Neurosurgical Department of the University Medical School of Graz by means of the gamma-Knife. 12 patients had recurrence after a single or several microsurgical resections. The age distribution was between 38 and 71 years with a mean of 57 years. The diameter of the tumors varied between 10.5 and 31.2 mm. RESULTS: In all 12 cases the tumors could be inactivated biologically in a mean follow-up period of 58.8 months by means of stereotactic radiosurgery. Tumor shrinkage was achieved in 3 cases (25%), central necrotic areas were observed in 8 cases (67%). No additional cranial nerve palsies occurred. CONCLUSIONS: Stereotactic radiosurgery has proven to be a safe and effective treatment option instead of repeated microsurgery. Stereotactic radiosurgery should be considered as the therapy of choice in cases of recurrent acoustic neuromas.

Adult↗
PubMed2001

Olfactory neuroblastoma (esthesioneuroblastoma): report of six cases treated by a novel combination of endoscopic surgery and radiosurgery.

Microsurgical techniques have considerably improved the results of surgical treatment for esthesioneuroblastoma (olfactory neuroblastoma). Nevertheless, these rare tumours of the frontal skull base are still associated with high rates of tumour recurrence and mortality, thus remaining a challenge even for experienced surgeons. A novel therapeutic approach that combines endoscopic sinus surgery and radiosurgery (gamma knife) is presented here. Six patients (3 males, 3 females) aged between 27 and 75 years (median 38 years) were treated between August 1993 and July 1999. Following paranasal and nasal endoscopic sinus surgery, marginal irradiation doses ranging from 16 to 34 Gy were applied radiosurgically involving up to 7 isocentres. At present, the median follow-up period is 57 months (range: 9 - 79 months). Without mortality, tumour control was achieved in all patients. One patient, who had to undergo additional craniotomy because of extensive neoplastic infiltration, developed postoperative liquorrhea. In another case the clinical course was complicated by a bilateral frontal sinusitis. All patients complained of nasal discharge and crusts. However, a preoperative Karnovsky Index ranging from 80 to 100 % remained stable in four patients whereas an improvement was observed in two patients. Based on the favourable results observed so far, the combination of endoscopic sinus surgery and radiosurgery can be considered as promising new option for the treatment of esthesioneuroblastoma that merits further investigation.

Adult↗
PubMed2001

[Configuration of ethmoid roof in children 0-14 years of age].

BACKGROUND: Knowledge of the unique anatomy of the nose, paranasal sinuses and skull base, particular concerning dangerously low positioned or deep lying cribriform plates is most important, as functional endoscopic sinus surgery has become an increasingly popular procedure for the management of pediatric sinus disease. OBJECTIVES AND METHODS: In addition to Keros who studied the ethmoidal roof and cribriform plate in 450 adult specimen and divided them into 3 groups, retrospective analysis in 272 patients between 0 and 14 years was performed by means of coronal CT scans of the paranasal sinuses with a slice thickness of 2 mm. Measurements were carried out in the frontal, middle and dorsal section of the ethmoid. RESULTS: The depth and width of the fossa olfactoria were significantly less in patients aged 0 - 12 months than in other age groups (p < 0.001). Among the other age groups, beginning at 2 years no differences were found: 14.2 % presented with type I according to Keros, 70.6 % with Keros II and 15.2 % with Keros III. The prevalence of asymmetric position of the ethmoidal roof was 15 % (41 patients). The height of the ethmoidal sinuses consistently increased over the years from 5 - 7 mm to 15 - 20 mm. CONCLUSION: The current data may serve as a reference for evaluation of normal and abnormal development of the roof of the ethmoid and may be of great value in diagnostic and therapeutic management of pediatric sinus disease. Our data obviously show that the classification into the 3 types of positions of the ethmoid roof and cribriform plate according to Keros is possible in children from the second year of life.

Adolescent↗
PubMed2000

Bilateral sensorineural hearing disorders in children: etiology of deafness and evaluation of hearing tests.

OBJECTIVE: The purpose of this study was to determine the etiology of bilateral sensorineural hearing disorders in children and to evaluate the performed hearing tests by comparison of the results of the objective and subjective tests. METHODS: The medical history and the hearing tests (behavioral observation audiometry, acoustic evoked potentials and pure tone audiometry) of 106 bilaterally hearing impaired children were analyzed in a retrospective follow-up study. RESULTS: The total group included 52 males and 54 females. The ages at first diagnosis ranged from 4 months to 11 years with a mean age of 42 months and a median of 33 months. The degree of hearing loss for the better hearing ear was mild in one child, moderate in 28 children, severe in 29 children, profound in 32 children and total in 16 children. The delay between the first examination and diagnosis ranged from 0 to 597 days with a mean of 83 days and a median of 28 days. In 47 children (44%) no cause of hearing impairment could be determined. Nineteen children (18%) had a history of familial hearing loss, 40 (38%) suffered from acquired hearing loss (seven children had prenatal causes, 21 perinatal and 12 postnatal). A comparison between behavioral observation audiometry and brainstem evoked response audiometry revealed a statistically good agreement. Twenty-nine children (32%) showed progressive hearing loss, which was defined as a threshold shift of +10 dB or more in the pure tone average in at least one ear. CONCLUSIONS: In a significant number of children with early hearing impairments the etiology still remains uncertain. Further research in the field of genetic disorders will diminish this number. Evaluation of hearing tests showed that behavioral observation audiometry still is an excellent tool in the hands of an experienced examiner. The age at identification of hearing disorders in industrialized countries still is unacceptably high. To obtain ideal care of hearing impaired children, universal neonatal hearing screening programs are mandatory.

Age Distribution↗
PubMed2000

[91 dB hearing loss--the threshold for cochlear implant?]].

BACKGROUND AND OBJECTIVE: Recent indications for cochlear implant in children are bilateral total cochlear deafness and an age of 2 or more. Reports on successful implantations in adults with residual hearing pose the question of whether this indication might be expanded to children with residual hearing. PATIENTS/METHODS: In a retrospective analysis of 106 hearing-impaired children with binaural amplification, we were able to ask parents in 90 cases about their children's education. The pure-tone average of the frequencies of 1-4 kHz was correlated to education. RESULTS: The results showed that all children except one with a pure-tone average of < or = 90 dB could successfully attend regular school or kindergarten. However, those with a pure-tone average of > or = 91 dB had to be educated in special units for children with impaired hearing. CONCLUSIONS: Our results indicate that amplification in children with profound hearing loss (pure-tone average > or = 91 dB) is not sufficiently effective to enable them to attend regular schools or kindergarten. We conclude that the only chance to integrate these children into the world of hearing might be cochlear implantation.

Adult↗
PubMed2000

[On the fate of lost gallstones].

The spilling of stones during laparoscopic cholecystectomy occurs in 10% of the operations. Late complications associated with this type of surgical procedure are abscesses and fistulas in the abdominal cavity and abdominal wall. The time elapsing between laparoscopy and clinical manifestation may be as long as 12 months. We present a case of a patient with localised abdominal pain in the upper right abdomen two months after laparoscopic cholecystectomy. Sonography and CT revealed a fat necrosis posterior of the rectus muscle. Examination of the histological specimen confirmed a fat necrosis caused by two small pigmented stones, spilled during laparoscopic cholecystectomy.

Abdominal Pain↗
PubMed2000

[A new therapy concept in esthesioneuroblastoma].

BACKGROUND: We introduce a new concept in treatment of esthesioneuroblastomas, developed in the University Medical School of Graz, Austria. PATIENTS AND METHODS: Six patients suffering from esthesioneuroblastoma have been treated in the years 1993-1999; five of them with a curative aspect, one with a palliative one. Three tumours were classified according to Kadish as stage B, three as stage C. The selection criteria included tumours without deep infiltration into the orbit nor into the pterygopalatine fossa and without any involvement of the posterior wall of the frontal sinus. The treatment consists of endoscopic nasal and paranasal sinus surgery and consecutive stereotactic radiosurgery by means of the Gamma-Knife unit. RESULTS: Over an average follow-up period of 38 months all patients remained free of disease. Because of the minimally invasive character of our concept the complications and side effects are minimised and the patients are less traumatised in comparison to conventional treatment such as craniofacial resection or irradiation. CONCLUSION: Due to the excellent outcome of our six patients we recommend this new treatment concept, in selected cases, as an alternative to the usual therapeutic modalities for esthesioneuroblastoma.

Adult↗
PubMed2000

The minimally invasive approach to olfactory neuroblastoma: combined endoscopic and stereotactic treatment.

OBJECTIVES: To describe a new treatment modality of olfactory neuroblastoma consisting of endoscopic nasal and paranasal sinus surgery and stereotactic radiosurgery. STUDY DESIGN: Retrospective review of three patients suffering from olfactory neuroblastoma. METHODS: Review of the charts, the computed tomography, and magnetic resonance imaging scans, the operation reports, radiosurgical data, and follow-up. RESULTS: All three patients remained free of disease with excellent quality of life in respective follow-up periods of 71, 50, and 39 months. CONCLUSION: The combination of two minimally invasive therapies, endoscopic sinus surgery and stereotactic radiosurgery, provide a reliable new approach to the treatment of a series of olfactory neuroblastomas that offers excellent quality of life, less injury to the patient, fewer side-effects, and fewer long-term effects than other treatment strategies.

Adult↗
PubMed1999

[Radiosurgery of acoustic neurinoma as a minimally invasive alternative to microsurgery].

From April 1992 to July 1998 stereotactic radiosurgery (Gamma Knife) was used to treat 1382 patients; 181 had acoustic neurinomas and were followed up, 44 of them for at least 4 years (48-75 months, median 60). With no mortality control of growth tumor was achieved in all cases but one. It was possible to preserve useful hearing in more than half of the patients (60%). In two patients complications due to the radiation with enlargement of the cystic component were observed. One patient needed additional microsurgical decompression. Three patients suffered transient incomplete facial palsy (one permanent, HBI III), and two patients complained of mild trigeminal neuropathy. One suffered from hydrocephalus and a shunting procedure was necessary. The neurological state improved in 23 patients (52%); five complained of new or worsened deficits. Radiosurgery is an effective alternative treatment for acoustic neurinomas with exceptionally low mortality and morbidity. With respect to preserving cranial nerve function the results are just as good as those of microsurgical resection. Short duration of hospitalization and quick return to normal activities make radiosurgery quite cost effective.

Adult↗
PubMed1999

Radiosurgery of vestibular schwannomas: a minimally invasive alternative to microsurgery.

From April 1992 till December 1998 stereotactic radiosurgery (Gamma Knife) was applied to 192 patients with vestibular schwannomas. 56 of them had radiosurgery as primary treatment modality and were followed-up for at least 4 years (48-80 months, median 62). Without fatal complications, control of tumour growth was achieved in all but three cases, useful hearing being preserved in more than one half of the patients (62%). The neurological state improved in 30 patients (54%). Irradiation-associated adverse effects (18%) comprised neurological signs (incomplete facial palsy, four cases (two recovered completely), and mild trigeminal neuropathy, three cases, respectively) and morphological changes (three patients) marked by an enlargement of pre-existing cystic components calling for additional surgical treatment: Microsurgical decompression was performed in two cases, the third patient underwent a shunting procedure because of hydrocephalus formation. Based on the present data, radiosurgery represents an effective treatment for vestibular schwannomas associated with an exceptionally low mortality rate and a good quality of life. With respect to the preservation of cranial nerve function, results are comparable to microsurgical resection. A short duration of hospitalization and a quick return to normal activities constitute further advantages and contribute to cost effectiveness in public health care.

Adolescent↗
PubMed1999

Plasma adrenaline concentrations during functional endoscopic sinus surgery.

OBJECTIVES/HYPOTHESIS: Vasoconstrictors (i.e., epinephrine) are routinely applied before functional endoscopic sinus surgery (FESS) but may have significant cardiac side effects. The controversy concerning clinical application of adrenaline is discussed. STUDY DESIGN: In a prospectively controlled study of 51 patients undergoing FESS we evaluated the absorption of adrenaline from standard cotton pledgets and submucous infiltration and the incidence of related side effects during surgery. Additionally, a control group of 12 patients undergoing tonsillectomy was investigated. METHODS: Plasma adrenaline concentrations were measured 1) before anesthesia, 2) after intubation, 3) after nasal packing with adrenaline soaked pledgets (adrenaline 1:1000) and submucous infiltration with 2 mL lidocaine with adrenaline 1:100,000 in each side, and 4) at end of surgery. The catecholamines were determined with a Merck-Hitachi Catecholamine Analyzer, model II (Merck, Darmstadt, Germany). Pulse, electrocardiogram (ECG), and blood pressure were monitored. RESULTS: In the FESS group, we found a remarkable decrease in systolic (S) as well as diastolic blood pressure (D) (P < .001), whereas the heart frequency was unaffected during surgery. All patients in the adrenaline group showed significant increase in plasma adrenaline (AD) concentrations in the third and fourth sample (P < .001). The control group, however, showed a significant rise in blood pressure only at beginning of surgery (P < .001) with cardiac pulse and plasma adrenaline concentrations unaffected by surgery or anesthesia. The often described severe side effects of adrenaline in combination with general anesthesia were not seen in any of our patients. CONCLUSIONS: Although systemic absorption of locally injected vasoconstrictors occurs, adrenaline-related side effects during FESS are extremely rare when the patient is monitored exactly.

Anesthesia, General↗