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Biomedical subjects

F Heppner

Publications and source records attributed to F Heppner.

At least 19 recordsLinked to original sources
PubMed1988

Endoscopic neurosurgery.

This paper describes an ultrasound-guided, laser-assisted, and TV-controlled endoscopic technique which has been used so far in 133 patients for a variety of intracranial lesions. Following CT or MRI image reconstruction, and a decision on the placement of a 1 cm or a 2 cm burrhole, a 1 cm 5.0 mHz or 7.5 mHz intraoperative ultrasound probe is used to direct the endoscope from the burrhole to the target area. A 22.5 cm long rigid endoscope tube with an outer diameter of 6 mm with an inbuilt suction irrigation system, Neodymium Yag laser with 600 micron Quartz glass-fibre and an inlet for various microinstruments is then introduced. The attachment of a TV camera to the ocular lens allows the operator to control further surgical steps in the target area via the TV screen and thus warrants sterility in the operating field. The technique has been used for evacuation of 77 spontaneous intracerebral haematomas (lobar, putaminal, thalamic), 8 traumatic intracerebral haematomas, 13 ventricular haematomas, 8 cerebellar haematomas and 1 brainstem haematoma. Total or subtotal evacuation was achieved in 33% of intracerebral haematomas, removal of more than 50% of the clot in 55%. Twenty-four brain tumours (12 ventricular, 12 cystic cerebral or cerebellar tumours) were operated on for biopsy, evacuation of cyst, resection or removal of the cyst wall and/or laser irradiation of solid tumour or the inner cyst wall of cystic tumours. The complication rate probably related to surgery was 1.6%, morbidity 1.6%, mortality 0%. This high-tec endoscopic technique with its minimal surgical trauma and short operation time can be recommended as a low-risk alternative to conventional neurosurgical techniques.

Adult↗
PubMed1987

[Local hyperthermia of malignant brain tumors].

In glioblastoma multiforme and high-grade astrocytomas the following procedure has been implemented to try and prevent recurrence: after extirpation of the tumour its bed is lined with metal powder and the patient's head is exposed to a high-frequency magnetic field every 4 weeks. As a result the temperature is raised by induction to +45 degrees C at the boundary between metal and brain tissue. This ought to be sufficient to prevent tumour recurrence. Varied results were achieved using this technique in 103 patients.

Brain Neoplasms↗
PubMed1987

CO2 laser surgery of intramedullary spinal cord tumors.

Of a total of 580 patients suffering from expanding spinal disease, 15 cases of intramedullary lesions were dealt with by the use of the CO2 laser. Sharp cutting and precisely controlled depth effect are the advantages that make the CO2 laser very useful for surgery within the spinal cord. In tumors of tough consistency the neoplastic tissue is usually sharply demarcated, in which case the CO2 laser is used for dissection along this borderline, at an output energy of 15-20 W, infocus, continuous wave (CW). In tumors of soft consistency, characterized by a more-or-less diffuse zone of invasion--eg, glioblastomas-vaporization [20 W, out-of-focus, CW] and removal by ultrasound-microsuction is recommended. This procedure should advance layer by layer until normal looking tissue is reached. In this way intramedullary tumors may be removed with minimal side effects. The postoperative course involves less pain and less edematous reaction, and the rehabilitation time is shortened compared with conventional surgical treatment. In benign neoplasms long-term results are good; malignant cases require additional x-ray treatment and chemotherapy.

Humans↗
PubMed1986

The glioblastoma multiforme: a lifelong challenge to the neurosurgeon.

During a period of 34 years 1316 gliomas of the brain have been treated, among them 508 glioblastomas (= 39%). In addition to the operative removal and postoperative X-ray therapy of glioblastomas various attempts have been undertaken to prevent recurrences: Intracerebral application of Cobalt60 (6 patients); locally applied antimitotic agents (76 patients); bacterial liquefaction induced by intracarotid administration of Clostridium butyricum M 55 spores ("Oncolysis", 67 patients); circumscribed heating of the extirpation cavity with metal and high-frequency electromagnetic field (85 patients); vaporization of the tumour bed with the defocussed CO2- or Neodymium-YAG-Laser beam (177 patients). Permanent cure has been attained only in single cases so that the problem does not yet seem to be definitely solved by any of these methods. However, bacterial oncolysis in combination with the periodic postoperative generation of heat locally in the excision cavity of the tumour, might justify cautious optimism about future developments.

Brachytherapy↗
PubMed1985

Direct surgical attack on pontine and rhombencephalic lesions.

The introduction of lasers in neurosurgery in 1976 can be considered as a major contribution to gaining access to "untouchable" areas of the brain. This immaterial instrument provides for precise cutting at low penetration depth in surrounding tissues and may carbonize, and thus remove, layers not to be touched because of their highly sensitive vicinity. From a total of 794 patients experiencing the advantages of laser surgery (1976-1984), a series of 12 children with lower brainstem tumors is presented. Intraoperative instability of vital functions was absent throughout, leaving the patients without deterioration of their initial neurological condition. Given appropriate handling and adequate experience, the laser is a singularly helpful surgical tool for gaining access to areas hitherto barred to surgery.

Adolescent↗
PubMed1985

Does acute endoscopic evacuation improve the outcome of patients with spontaneous intracerebral hemorrhage?

A new endoscopic technique is presented, which allows burr hole evacuation of intracerebral hematomas under video control. Clot removal is achieved using a suction-irrigation system built in the 6-mm-diameter endoscope; in addition, an ultrasonic morcellement device has been developed for transendoscopic application. Small bleeding vessels in the hematoma cavity can be coagulated using a 1.5 mm Neodym YAG Laser microprobe introduced through the endoscope under visual control. A randomized prospective study has been started to raise again the question of indications for the surgical treatment of intracerebral hemorrhages, comparing medical treatment with the new surgical technique.

Acute Disease↗
PubMed1984

Flow patterns at the site of extracranial to intracranial end to side anastomosis. An experimental rheological study.

Flow property measurements were performed in a plexiglass model of six various types of end-to-side anastomosis (as clinically shown in extracranial to intracranial arterial bypass surgery). Three anastomoses were made without, another three anastomoses with a ringshaped stenosis restricting the lumen to between 25 and 46% of the cross-section as it occurs clinically by formation of thrombi out of the striching canals. A rectangular type and two of 45 degree oblique types--one directed centrally and one directed peripherally--were tested. Pressure head losses at the site of anastomosis were measured under various circumstances of different anastomoses and different flow speeds along the proximal portion of the middle cerebral artery and the superficial temporal artery. Flow resistance values originated by the different types of anastomoses were expressed in terms of additional recipient vessel length. Differences between different types of anastomoses with and without stenosis were very small and under no circumstances exceeded the equivalent of lengthening the recipient vessel by 2 cm. Theoretically, the optimal type of anastomosis is the oblique and centrally directed version; the worst type is the rectangular form. Practically, however, such differences are not relevant. The explanation for such unexpectedly small differences can rheologically be given by considering the dominating role of blood viscosity under the given circumstances, other variables such as short stenosis and angling of flow playing a secondary role.

Animals↗
PubMed1984

CO2-Laser in neurosurgery.

New technical tools in surgery are only beneficial if they offer real improvements compared to the traditional techniques or if they open absolute new indications in surgery. Therefore we have tried to find absolute indications for the use of the indifferent laser system. Due to the specific wavelength the CO2-Laser is entirely absorbed at the surface. This specific performance allows one to use the CO2-Laser as the most precise cutting and as a completely new vaporizing instrument. It has become an irreplaceable tool in surgery of central lesions and brain stem tumours and also for spinal cord tumours. In addition the CO2-Laser is adaptable to the operating microscope. A gain of the same importance in the meantime is the Nd-YAG Laser, which works specially for coagulation, volume coagulation and endoscopic use. It is certain that laser surgery will evolve for beyond our imagination.

Animals↗
PubMed1980

[Natural history and operative treatment of intracranial aneurysms after subarachnoid haemorrhage (author's transl)].

This report presents an evaluation of prognosis in 227 patients with subarachnoid haemorrhage caused by intracranial aneurysm, comparing operative treatment in 118 patients with conservative treatment in 109. In all operable cases, the prognosis following early surgery was better than that of conservative treatment. Statistical comparison of patient groups according to the clinical condition allowed the formation of guidelines for the optimal timing of surgery: patients in good clinical condition should be operated on at the earliest possible moment. The overall mortality with such a policy is lower than with a waiting policy, since the majority of recurrences occurred within 2 weeks. Patients with disturbed consciousness and neurological deficit are best operated on either within 24 hours or following stabilization or improvement of the clinical picture -- mostly after 2 weeks. The risk of rebleeding is much lower in these cases, which justifies awaiting optimum clinical conditions. Surgery on comatose patients is contraindicated.

Female↗
PubMed1980

Predicting lethal outcome after severe head injury -- a computer-assisted analysis of neurological symptoms and laboratory values.

A total number of 58 parameters (laboratory values, neurological symptoms, and vegetative parameters) were evaluated in 150 patients during the first seven days after severe head injury. The patients were divided into two groups, "survivors" and "non-survivors". Eight easily evaluable routine parameters with the most significant differences between the two groups of patients were used for statistical evaluation of a "no survival chance score". These highly indicative parameters are serum osmolarity and urea, blood glucose, total bilirubin, motor reaction to stimuli, body temperature, respiratory activity, and pupil reaction. A "low survival chance limit" was evaluated from each of these parameters by computer analysis. None of the patients in the series survived when three or more of these eight parameters had climbed beyond the limit. So far, the system is able to predict "no survival chances" in 50.8% of the non-survivors some six days prior to death; 80% of these predictions could be made by the fourth day after injury.

Adolescent↗
PubMed1979

[Psychosurgery today (author's transl)].

After discussion of the historical and neurophysiological bases of psychosurgery a report on personal experience in different indications is given. Finally, the present degree of informedness of doctors and the media on psychosurgery is discussed.

Aggression↗
PubMed1979

[Therapy of traumatic brain edema with spironolactone (author's transl)].

In 30 patients with severe brain injury a double-blind study was performed. The effectiveness of the aldosterone-antagonist Aldactone pro injectione was examined in therapy of traumatic brain edema. The results indicate elimination of sodium and water from brain cells and white matter. Concomitantly faster improvement of state of consciousness was observed.

Adolescent↗