Biomedical subjects
Publications and source records attributed to H Fried.
The authors discuss 21 epidermoids and 6 dermoids of the craniocerebral region, which occurred in patients of the Leipzig Neurosurgical Clinic within a period of ten years. Main localisation was the sellar region. The clinical symptoms (frequently with lacking signs of brain pressure), the diagnosis and prognosis of the malformation tumours are dealt with.
After a short historical survey will be reported about the actual position of neurosurgery, with special aspects to problems of operative techniques. The consequences of the tendencies of development of neurosurgery are discussed.
Central dimer-X-ventriculography is a method that should not be renounced even in our time when computer tomography is available. It provides a high degree of accuracy of the results of the diagnosis of tumours of the 4th ventricle and is also suitable for postoperative check-ups with the rate of complications appearing to be very small.
From a total of 1,028 infratentorial tumours operated on at the Neurosurgical Hospital of the Section Medicine of the Karl-Marx University Leipzig in the last 30 years, 167 tumours in the region of the 4th ventrical have been selected. Their statistical processing was carried out with respect to specific localisation, average age, kind of tumour, sex, clinical findings, duration of case history, application of instrumental diagnostic procedures and radicality of operation, success and failure. Some fundamental conclussions are drawn. A subdivision in detail will be contained in the following articles based on this material.
Within 30 years, 1028 operations because of cerebellar tumours have been carried out at the Neurosurgical University Hospital in Leipzig. Of these, 167 were related to tumours within the 4th ventricle or encroaching a little outside of it. In the group of the adults (from the 18th year), 54 observations were made. These patients are subdivided according to histology (ependymomas in the first place), according to clinical findings (high values of cerebral pressure symptoms), according to the duration of the case history in dependence upon histology (long duration of angioblastomas and ependymomas), according to the possibilities of radicality (somewhat below the values in child age), the condition at discharge (better than in child age) and the cause of death (absolute predominance of central causes). A comparison is made with the results obtained with the studied patients in child age. Subsequently, the operation tactics of the Leipzig hospital is dealt with and the respective value of microneurosurgery carried out 10 years before is emphasised. A striking improvement for benign tumours can now only be achieved by a considerably improved early diagnosis.
A report is given on 113 tumours of the 4th ventricle in children (up to the age of 18 years) observed among a total of 1028 cerebellar operations. Of these, 87 (= 77%) tumours were exclusively tumours of the 4th ventricle, in 26 cases the tumour also encroached on adjacent structures (cerebellar hemisphere and vermis, pons and Medulla oblongata). Medulloblastomas were predominant (55%), they mainly occurred in school age. Leading clinical symptom of the tumours of the 4th ventricle - especially in child age - is the increase in intracranial pressure which can often be demonstrated radiologically in this age group. Besides there are coordination disturbances and disturbances of the cerebral nerves; relatively frequently one sees a "vermis syndrome". The initial symptoms, which are in most cases non-characteristic (nausea, headache, also ataxia), are more often than not misinterpreted. Surgically treatment aims at a radical removal of the tumour whenever of possible, which is frequently problematic in children, and the restoration of the pathways the cerebrospinal fluid. Microsurgical techniques clearly contributed to a decrease in the mortality rate which, however, still is very high. This stresses the importance of an improvement of early recognition of these tumours.
Tumours in the region of the Foramen magnum are rare (34 cases among more than 1000 infratentorial and 400 spinal tumours). The clinical symptoms can be guiding but they sometimes involve differential-diagnostic difficulties. In dependence upon the starting point and the direction of the development, cerebellar signs or transverse paralysis in the cervical region of the medulla are in the fore. In most cases, supplementary examinations are indispensable (X-ray examinations of the skull and the cervical vertebral column, ventriculography and CT). Angiography is of lesser importance. The anatomical relations of the tumour to its environment not only form the clinical picture, but also bring about therapeutical problems. The use of microsurgical methods has improved the prognosis a little, but nevertheless these disease pictures should be considered to be very serious.
A report is given on a pontine tumour with intrasellar cyst formation which, as it was suspected to be a hypophyseal tumour, was first treated transsphenoidally and then under the picture of an empty-sella syndrome was re-operated on subfrontally twice in an interval of ten years.
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A 5-year-old boy presented with a 7-month history of headache and projectile vomiting. Computerized axial tomography revealed a large, high density lesion involving the entire left frontal lobe. At operation a 330-g, apparently encapsulated, mildly cystic neoplasm was removed from the region of the left frontal operculum. Microscopic examination demonstrated moderately cellular astrocytic tissue interspersed with several large, bizarre, and occasionally binucleate ganglion cells. The pathological entity of ganglioglioma is briefly reviewed.
In a period of 15 years, 16 intracranial meningiomas of the childhood and adolescence were examined radiologically. The neuroradiological findings obtained are analysed and compared with those obtained in adults. The particularities resulting from this comparison, which above all concern the angiographic picture of meningiomas in juvenile patients, are worked out and discussed. As a result, some conclusions can be drawn which may be of practical importance: As is the case with other cerebral tumours in childhood, meningiomas in most cases give rise to reliable radiological signs of an increase in intracranial pressure. The changes of the cranial bones indicating the presence of a meningioma, which are well-known signs in adults, are found in children almost as frequently. While pneumo-encephalography in most cases permits a reliable localisation of the tumour, it does not permit a diagnostic statement with respect to the kind of the tumour. In three patients the air filling made larger cysts visible which obviously occur more frequently in children than in adults. The angiographic picture of meningiomas in childhood often differs from that in adults with regard to the vascularisation type as well as the phase course, so that differential-diagnostic difficulties may arise. However, when considering the above mentioned peculiarities of the vascular picture of memingiomas in children, it appears to be possible to make a preoperative diagnosis of the kind of the tumour with the help of the angiogram also for children. The increased vascular supply via branches of the A. carotis externa, which is frequently found in neningiomas, cannot in our opinion be considered as a decisive type-diagnostic criterion; it must be considered as an expression of an increased participation of the dura and thus also occurs in other space-occupying intracranial processes.
A comparative study of 150 carotid angiographies carried out under local anaesthesia and the same number under halothane anaesthesia did not show any great deviation from the well-known filling rates of the counter-lateral carotid region and the ipsilateral A. cerebri posterior nor any striking differences in the two methods of anaesthesia which could convince of a favourable influence of halothane on the demonstration of the vessels. The causative factors of the filling of adjacent vascularisation regions can certainly only be explained from the complex co-action of physiological and any external factors in cerebral angiography.
In this paper, some aspects are discussed which are of importance for the indication for an operation because of gliomatous cerebral tumours. Among these, there are, for example, the histopathological findings, the patient's age, the period of anamnesis, and the time interval between the first operation and the recurrence, the degree of radical surgery for the removal of the tumour and the postoperative course as well as location and extension of the process. Problems of instrumental diagnosis of relapsing cerebral gliomas are briefly discussed. In conclusion, the paper gives a critical analysis of the results obtained in the surgery of glioma relapses.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.