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G Kessel

Publications and source records attributed to G Kessel.

8 recordsLinked to original sources
PubMed1998

Sensitivity and specificity of MRA in the diagnosis of neurovascular compression in patients with trigeminal neuralgia. A correlation of MRA and surgical findings.

The published rates of operatively confirmed neurovascular compression as the cause for trigeminal neuralgia range from 10% to nearly 100%. High-definition magnetic resonance angiography (MRA) was performed in 27 consecutive patients (in 6 cases with 3D reconstructions) to show neurovascular compression preoperatively. The MRA findings were compared with the relationship between the Vth nerve and the surrounding vessels at surgery. In 23 patients MRA showed present neurovascular compression in accordance with surgical findings (18/27 in complete accordance of type and side of vessel, site and direction of compression). One woman had no neurovascular compression either on MRA or intraoperatively. One MRA prediction of neurovascular compression was false, and two results were false negative. The sensitivity of MRA was therefore 88.5% but the specificity only 50%, if surgical findings are the reference. In one patient with right trigeminal neuralgia MRA revealed bilateral neurovascular compression of the Vth nerves. Therefore, the overall specificity of MRA might be below 50%. In one patient with multiple sclerosis, the decision to operate was markedly influenced by the clear finding of neurovascular compression on MRA. The patient has been free from trigeminal pain for 149 weeks after microvascular decompression. In 6 patients, 3D reconstructions of the MRA data were performed. The images helped in 3D visualisation of the operation, but did not yield new information about the nature of the vessels revealed, or the site, direction or side of the neurovascular compression.

Cerebellopontine Angle↗
PubMed1998

Cerebral blood flow velocities after subarachnoid haemorrhage in relation to the amount of blood clots in the initial computed tomography.

In 72 patients with acute subarachnoid haemorrhage (SAH) the relationship between the amount of subarachnoid blood clots detected by initial cranial computed tomography (CCT) up to 48 hours after bleeding and the later development of vasospasm, established by blood flow velocity measurement with transcranial Doppler ultrasound (TCD) was investigated. The serial Doppler examinations started within the first 72 hours after SAH and were carried out every second day up to three weeks. Each Doppler recording was accompanied by a neurological examination. Patients classified as Hunt and Hess grade V were excluded from the study. All patients with remarkable brain oedema in CCT or with intracranial pressure above 25 mmHg were also excluded. Because of the well known age-dependence of vasospasm after SAH, two age groups were formed. A statistically significant correlation (p > 0.05) between blood flow velocities and blood load after SAH was not found. The mean age of the investigated 72 individuals was 48.9 years (14 up to 76 years). 47 patients were younger than 56 years. Linear regression analysis indicated a correlation with a quite low significance level (r = 0.350, p < 0.025) between TCD blood flow velocities and blood load in CCT in these younger subjects. No significant correlation (p > 0.05) between these two variables could be established in the 25 patients older than 55 years. In a second step an intra-individual comparison of side-to-side differences in TCD and CCT was made. There were no significant differences in blood flow velocities between subjects with or without side-to-side differences in cisternal blood load. It is concluded that the amount of blood visible on initial CCT after SAH is not a powerful predictor of cerebral blood flow velocities measured by TCD.

Adolescent↗
PubMed1997

The role of endoscopy in the treatment of acute traumatic anterior epidural hematoma of the cervical spine: case report.

OBJECTIVE AND IMPORTANCE: Epidural hematoma (EDH) of the spine represents an uncommon neurosurgical disorder that sometimes requires emergent surgical decompressive therapy. Traumatic EDH of the cervical spine is exceedingly rare. The hematoma is usually located dorsally in the epidural space. We present one case of acute EDH located ventrally in the cervical spine. Special emphasis is placed on the role of spinal endoscopy in surgical treatment. CLINICAL PRESENTATION: After a fall from a tree, a 69-year-old man with rapidly increasing tetraparesis was referred to our institution. Plain films of the cervical spine revealed nothing abnormal. The results of computed tomography were highly suspicious for EDH. A myelogram and a post-myelographic computed tomographic scan demonstrated the lesion and its extent craniocaudally. INTERVENTION: Emergency decompressive surgery and removal of the hematoma were performed via an anterior approach. Control for total removal of the EDH was achieved using a flexible neuroendoscope providing visualization of the anterior epidural space from the foramen magnum to the T1 level. Surgery was accomplished by vertebral body replacement and anterior plating. CONCLUSION: Spinal endoscopy seems to be a useful tool in the surgical treatment of spinal EDH, providing control of the adjacent levels and allowing the limitation of the extent of bony resection.

Aged↗
PubMed1996

Stereotactically guided cavernous malformation surgery.

The incidence of a significant hemorrhage in the natural history of cavernomas is below 1% per year, but the risk of a second hemorrhage in patients with initial bleeding cavernomas is between 14% and 29%. In the light of these figures, all cavernomas ought to be resected if surgical-related morbidity can be minimized. Stereotactically guided neurosurgery offers the advantage of planning the least traumatic approach before craniotomy due to the knowledge of the exact localisation of the lesion. During a 2-year period 12 patients (age 16-54 years) with intracranial supratentorial cavernomas (size 0.5-1.8 cm) were treated by stereotactically guided microsurgery. The cavernomas were seated in a depth between 0.4 and 4.5 cm. 4 patients had an overt hemorrhage in their history. In six cases a seizure was the first symptom (altogether 8 patients had seizures preoperatively). Two patients were asymptomatic. Standard CRW (Cosman, Roberts, Wells) stereotactic system was used in all cases. The skin incision and the osteoplastic craniotomy (mean diameter 2.8 cm) were planned stereotactically. In 11 patients a transsulcal approach was used. The size of the corticotomy could be limited to less than 1 cm. Using the stereotactic method, all cavernomas were found with a high degree of accuracy. After lesionectomy a total of 1 to 2 mm of the surrounding yellow-stained brain tissue was sucked away because it contains hemosiderin and therefore iron, which may have an epileptogenic effect. No relevant surgical-related neurological morbidity was found in any patient a half year after surgery. Seven out of eight patients were free of seizures. One still had problems.

Adolescent↗
PubMed1989

Arterio-venous malformations in childhood: clinical presentation, results after operative treatment and long-term follow-up.

In a series of 182 arterio-venous malformations (AVM) recently published we found 33 children aged 1 to 16 years. In 28 cases, the admitting condition was hemorrhage. For 31 AVMs total excision was possible. We observed one postoperative death accounting for a mortality of 3%. All children but two were followed-up by personal examination. Two were not able to work due to severe neurological deficits and seven had not been able to get into their intended occupation.

Adolescent↗