[Cervical nerve root compression syndrome caused by the vertebral artery].
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Angiography, Digital Subtraction↗
Biomedical subjects
H E Clar
Publications and source records attributed to H E Clar.
[Occlusion of the intracranial segment of the carotid artery by a hypophyseal tumor].
A patient of 49 years of age presented with clinical signs of acute stroke. Computed tomography revealed a suprasellar mass and cerebral infarct. Angiographically an occlusion of the intracavernous internal carotid artery was found, caused by pituitary tumour. After total removal of the tumour the internal carotid artery was recanalised, as the postoperative angiography showed. The patient's neurological deficiencies disappeared almost completely. The literature is reviewed and our diagnosis and procedures are compared with the published reports.
Adenoma, Chromophobe↗
Diagnostic criteria in pituitary tumour recurrence--combined modality of surgery and radiotherapy.
The tumour recurrence rate of 210 patients with operated hypophysomas were investigated. Depending on the surgical approach, total or subtotal extirpation of the adenomas, the recurrence rates varied from 10,4 to 35%. 33 patients with pituitary tumour recurrences were followed up over a period of 20 years. Clinical symptoms CT-results at relapse are represented. Serum prolactin level (PRL) was determined before and after surgical and radiotherapy of PRL-producing adenomas. In these cases PRL can be accepted as a tumour marker. 13 patients with relapsed hypophysomas received local irradiation (5.7 MeV linear accelerator) after recurrence operation. An individual comparison in the same patient between surgical therapy alone and combined surgical and radiotherapy was possible. Based on the obtained experience with this combined treatment a therapy scheme using combined surgery and radiotherapy in pituitary tumours is suggested.
Adenoma↗
Tumors of the pineal region in children and adolescents.
The treatment of tumors in the pineal area remains controversial. There are two main approaches: Conservative treatment, consisting in CSF shunting and radiotherapy, and direct surgical removal. We report on 25 children (22 boys and 3 girls) aged between 4 and 20 years who underwent conservative treatment. The follow-up period ranges from 1 to 11 years (mean, 4.8 years). 19 patients are still alive at a mean survival time of 5.8 years. 17 children are free of disease, two have severe neurological deficits. Our diagnostic and therapeutical concepts are presented.
Adolescent↗
Disturbances of the hypothalamic thermoregulation.
Although compression of the hypothalamus in cases of suprasellar tumour is common, spontaneous dysregulation of body temperature is extremely rare. Bilateral localization of the hypothalamic nuclei and a high grade of compensatory value of temperature regulation may be the reason for this phenomenon. In the postoperative period temperature dysregulation is observed more often. In order to analyse the influence of diencephalic regulation in these patients classification of the degree of hypothalamic compression is necessary. The problem was studied under experimental and clinical conditions. Experimental studies in rabbits after acute hypothalamic compression and decompression showed a reversible disturbances of temperature regulation. Hypothalamic compression in dogs resulted in reversible hypothalamic endocrine dysfunction. Clinical observations of body temperature in the period after operation of suprasellar tumors showed similar results. The temperature study was extended on patients with cerebral trauma and intracranial haemorrhage to differentiate the degree of hypothalamic lesion. Morphological examinations confirmed alterations localized in the anterior and posterior region of the hypothalamus. The analysis proved the fact that temperature regulation seems to be a highly sensitive parameter of diencephalic function.
Adenoma↗
[Therapy of brain stem tumors--palliative concept with a curative perspective?].
From 1969 to 1981, 23 patients with tumors in the pons region were irradiated at the Department of Radiotherapy of the West German Tumor Center in Essen. The age of the patients ranged from 18 months to 50 years. Fifteen patients (65%) were younger than 18 years, one was 25 years old, and seven were between 40 and 50 years old. In two cases the histologic diagnosis of an astrocytoma I and astrocytoma II could be confirmed by exploratory excision and cyst punction, respectively. Nineteen patients received a shunt system (ventriculoatrial shunt) prior to radiotherapy in order to achieve a pressure reduction. After a follow-up period of 1.5 to 12 years, eleven patients are alive, and twelve patients died from a local recurrence or from progressive tumor growth. The five-year survival rate is 47%. Five of the surviving patients show no or only slight adverse effects on their general condition and are able to attend school or carry out their profession (in Karnofsky: 90 to 100%). Four other patients suffering from marked remaining neurologic symptoms are able to take care of themselves (Karnofsky: 70 to 80%). Two patients need permanent nursing (Karnofsky: 50 to 60%). Because of the local propagation tendency of pons tumors, radiotherapy should be locally restricted to the brain stem and the adjacent brain structures, e.g. cerebellum and proximal neck marrow. The authors recommend target volumes of 55 to 60 Gy, which must be applied within 6 to 8 weeks, taking into account the age of patients. This palliative therapy conception should be applied routinely in the hope of bringing about a curative treatment to this group of patients.
Adolescent↗
[Therapy of hormone-active hypophyseal tumors from a neurosurgical viewpoint].
Perioperative hormone determinations were performed in 16 patients with acromegaly, in 12 patients with prolactinomas and in 4 patients with tumours producing ACTH. These determinations are an essential basis for assessing the results of the operation. Surgical treatment is the method of choice in hormone-active tumours if reduction of the elevated hormone values cannot be achieved with drug treatment. An exponential lowering of the hormone level can be obtained in acromegaly and in tumours producing ACTH. Although levels above 100 ng/ml could be reduced, it was not possible to restore them to standard values. In some cases, it was possible to lower the prolactin level, but normal values could never be obtained because of the size of tumours. The consequences resulting from these findings (drug treatment and radiotherapy) are discussed.
Acromegaly↗
[Hemorrhage in hypophyseal tumors and in the chiasm area--urgent surgical indications].
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Adenoma↗
[Computertomographic and morphological findings in cerebral infarctions and intracerebral haematomas in identical sections (author's transl)].
The paper deals with computertomographic and morphological studies in patients who died suffering from brain ischaemia, haemorrhagical infarction and haemorrhages. These examinations were done in identical sections. Methodically computerized tomograms in living patients, postmortal tomograms, brain sections and macrosections were used. Not in all cases corresponding findings were observed, due to the following factors 1. Size of the lesion 2. Localisation 3. Time of examination 4. Premortal alterations. The different factors are discussed in detail.
Adult↗
[Pain as an early symptom of spinal diseases].
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Abscess↗
Clinical and morphological studies of pineal tumours.
This is a report of clinical, morphological, diagnostic, endocrinological and therapeutical experiences with 18 patients with tumours in the pineal region. The histological diagnosis was verified in four cases by autopsy, in seven cases by biopsy, and in one case by microscopical verification of tumour cells in the CSF. In all biopsy cases we are dealing with typical germinomas. In the other clinical cases diagnosis was made by neuroradiological and endocrinological methods. The localization was possible by encephalotomography or CT scan, according to Kageyama, Particular attention was given to the endocrinological dysfunctions which originate in the hypothalamus. Also the hypothalamic dysfunctions after irradiation were discussed. Since the results of primary surgical approach and biopsy have been unsatisfactory, we preferred a non-operative schedule for treatment of pineal tumours.
Biopsy↗
Pre- and postoperative evaluation of hypothalamo- pituitary function in children with craniopharyngiomas.
Pre- and postoperative evaluation of hypothalamic-pituitary function was performed in six children, aged 5.5 to 13.3 years with craniopharyngiomas. Before surgery growth hormone deficiency (GHD) was documented in four, hypothalamic hypothyroidism in three, and secondary ACTH-deficiency and hyperprolactinaemia in one patient. Diabetes insipidus was absent in all patients. After neurosurgical treatment GHD was present in all, hypothyroidism in five, ACTH-deficiency in three, hyperprolactinaemia in three, and diabetes insipidus in four children. The study shows that all endocrine functions tested may be defective even before surgery, although diabetes insipidus seems to be a rare preoperative complaint. Surgical intervention, however, often leads to additional endocrine disorders. From the data presented here one may suggest that TRH stimulation tests, evaluation of serum prolactin, and lysin-vasopressin stimulation tests are the most useful investigations to distinguish between hypothalamic and primary pituitary disorders.
Adolescent↗
Clinical and morphological studies of pituitary and diencephalic space-occupying lesions before and after operation, with special reference to temperature regulation.
In this study investigations are reported which analyze the clinical and morphological results in the treatment of diencephalic tumours. Depending on their location, these tumours are classified according to the extent of hypothalamic compression. The following parameters were studied: body temperature, blood pressure, pulse rate, serum electrolytes, water balance, and serum glucose. Hormonal tests were carried out to detect disturbances of pituitary and diencephalic function. The clinical findings were verified by morphological study of the hypothalamus in serial sections. The study covers 193 patients with sellar and diencephalic tumours. This analysis led to the following conclusions: 1. The postoperative temperature course is a reliable parameter for the diagnosis of diencephalic damage. 2. Diabetes insipidus is evidence of a diencephalic lesion. 3. Disturbances in the regulation of the serum glucose, electrolytes, blood pressure, and pulse rate are signs of a diffuse diencephalic lesion. 4. Endocrinological disturbances in the late phase indicate permanent diencephalic damage. This study indicates that the clinical findings in the acute postoperative period permit evaluation of the extent of the hypothalamic damage. These findings are consistent with Rothballer's observations on the pre-operative evaluation of these tumours.
Arrhythmias, Cardiac↗
Comparison of encephalotomograms and computerized tomograms in midline tumours in infants.
Even after the introduction of the computerized tomogram, midline tumours in infants may give diagnostic problems. In the present study 41 children with tumours in the midline were investigated by both computerized tomography and encephalotomography. The results could be divided into two groups, according to the method and according to the localization of the space-occupying lesion. The diagnostic procedure may be restricted to computerized tomography in cases with direct signs (density differences, contrast enhancement). In cases showing indirect signs on the computerized tomogram (dislocation of ventricles or cisterns or both), further investigation would appear to be valuable. Encephalotomography is the method of choice in patients with negative or uncertain CT findings and contradictory clinical symptomatology.
Brain Neoplasms↗
Classification of tumours in the sellar region using CT and encephalotomography.
Tumours in the sellar region may still present diagnostic problems. We therefore compared encephalotomographic and CT findings in sellar tumours and 91 patients were examined by both methods. For clinical purposes and operative treatment the degree of compression of the hypothalamus is of great importance. Encephalotomographic and CT findings are analysed and demonstrated. In cases of density differences between tumour and brain tissue shown by contrast enhancement, more information on the inner structure of a tumour (cystic or solid) can be obtained by computerized tomography. But if these are no density differences or/and contrast enhancement, tumour diagnosis is made easier by encephalotomography because of the great efficiency of this method.
Adenoma, Acidophil↗
[Current status of the neurologic-neurosurgical diagnosis].
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Cerebral Angiography↗
[Diagnosis of diencephalic disorders. Clinical study on the diagnosis of diencephalic disorders before and after surgery of tumors in the region of the sella and the diencephalon].
The clinical symptomatology of diencephalic disorders is studied in 193 patients operated because of tumors in the sellar region. A new classification of these tumors is established according to the localization and degree of compression of the hypothalamus. The following parameters were examined: body temperature, blood pressure, pulse rate, electrolytes, fluid balance, and serum glucose. In addition, hormonal tests for hypophyseal and diencephalic disorders were carried out. The analysis shows a significant postoperative temperature rise in patients with tumors in the hypothalamic region, depending on the degree of compression of the hypothalamus. There is no relation to histological findings or form of operative approach. Postoperative diabetes insipidus as well as endocrine diencephalic disorders correlate also with the degree of diencephalic lesion. The same results were found with glucose regulation. In contrast, blood pressure, pulse rate, and electrolytes show no differences in the groups tested.
Blood Glucose↗
Limitations of computerized tomography in diagnosis of subdural hematoma.
CT findings in 51 patients with subdural hematomas are studied. Direct signs (hyperdensity, hypodensity) and indirect signs (any form of mass lesion) are distinguished. CT is limited with regard to determining correlations between time and the attenuation values. The factors which influence density of the hematoma are discussed. For a rational approach with subdural hematomas, which present diagnostic problems and reveal the limitations of CT diagnosis, a diagnostic scheme is proposed.
Cerebral Angiography↗