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Biomedical subjects

J Gilsbach

Publications and source records attributed to J Gilsbach.

At least 37 records · Page 2Linked to original sources
PubMed1991

Transsigmoid approach for tumors of the jugular foramen.

A transsigmoid approach is detailed for removal of tumors involving the jugular foramen. This approach was used in seven patients, eliminates the need for facial nerve transposition, and helps to preserve cochleovestibular function. The sigmoid sinus is packed and both the facial nerve and the labyrinth are identified. This approach provides excellent vision of the intradural and extradural course of the lower cranial nerves, rendering preservation of isolated nerves within the neural compartment feasible.

Journal Article↗
PubMed1989

Pituitary adenoma and meningioma in the same patient. Report of three cases.

Three patients are presented in whom both pituitary adenoma and meningioma were found. The pituitary tumour was a prolactinoma in one case and non-secreting adenoma in the other two. In one case the meningioma originated from the planum sphenoidale and was seperate from the pituitary adenoma. Another patient had a parasellar meningioma, which was suspected preoperatively by different enhancement on the CT scan. In the third case, both tumours were mainly infradiaphragmatic and could not be differentiated preoperatively or intraoperatively. This appears to be the first case with both tumours below the diaphragm. The clinical, radiological and histopathological findings are presented.

Adenoma↗
PubMed1989

The state of the frontal sinus after craniotomy.

In 39 patients, 24 male, 15 female, the frontal sinus was opened during a frontal, a bifrontal or a pterional trephination for neurosurgical treatment of trauma, tumours or aneurysms. In 25 out of 39 patients the frontal sinus subsequently was obliterated, in 11 out of 39 patients the apical half or 2/3 of the sinus were ablated and the remaining caudal part covered with a galea periosteal flap leaving the fronto-nasal duct intact. In 3 out of 39 patients, the periphery of the sinus was ablated and the remaining part covered. All patients were followed over a mean period of 2 years and had a final evaluation using CTs, X-rays, ultrasonography and a complete ENT examination. In 4 out of 25 obliteration was successful and complete, in 16 out of 25 there was a partial or complete re-aeration of the residual sinus and in 5 out of 25 the sinus was infected. In one out of eleven patients where the frontal sinus was bisected with preservation of the lower half, the basal part of the sinus was infected, in 10 out of 11 the residual sinus was aerated and draining well. In one out of three patients where the periphery of the sinus was ablated, there was infection, two of three sinuses were aerated. Evaluating the experience in these 39 patients and our recent experience, obliteration of the sinus with muscle is very unreliable and the use of bone wax is obsolete. Covering a bisected or peripherally opened sinus with fascia or a galea periosteal flap will yield a well aerated and draining sinus, provided the naso-frontal duct is intact.

Adolescent↗
PubMed1988

The microvascular Doppler--an intraoperative tool for the treatment of large and giant aneurysms.

One of the problems especially associated with large and giant aneurysms is the control of the patency of the parent artery and the exclusion of the aneurysm. While the exclusion can be tested by puncture (which may sometimes be problematic), the patency can only be controlled by intraoperative angiography or recently, by microvascular intraoperative Doppler. The device we use has a high resolution and is equipped with probes as small as 0.3 mm with which all visible vessels with diameters of more than 0.1 mm can be investigated. Local stenoses above a diameter reduction of 40% can be easily detected by localized accelerations and changes in the pulse curves. Our recent experience with 11 giant and 13 large aneurysms has revealed marked discrepancies between an apparently well placed clip and an obviously open vessel on the one hand, and the haemodynamic reality revealed by the Doppler on the other. We were able to decide whether the flow was undisturbed, or whether there was an haemodynamically non-effective lumen reduction due to a tight clip, or if there was severe stenosis or a total occlusion. In five cases with severely disturbed flow after clipping, we had to change our strategy: we resected the aneurysms and sutured the neck, performed an end-to-end anastomosis, coated the aneurysm, or repositioned the clips. In cases in which we did not have full view of the neck, the Doppler guided us to a proper clip position. We conclude that especially for large and giant aneurysms, the microvascular interoperative Doppler is a valuable tool.

Adult↗
PubMed1988

Haemodynamic effectiveness of nimodipine on spastic brain vessels after subarachnoid haemorrhage evaluated by the transcranial Doppler method. A review of clinical studies.

The authors review the literature reports and own results of a double-blind study of the effectiveness of nimodipine on prevention or treatment of spasm of cerebral arteries following subarachnoid haemorrhage (SAH). Spasm has been evaluated using the transcranial Doppler method (TCD). The patients were divided into two groups which received 2 resp. 3 mg/h nimodipine. The clinical outcome and also the incidence of spasm of both of the groups were not different, but spasm was less severe in the 3 mg/h group.

Blood Flow Velocity↗
PubMed1988

Neuropsychological assessment of the transcallosal approach.

The long-term consequences of partial callosal lesions were examined in 7 neurosurgically treated patients. Detailed clinical and neuropsychological assessment of the interhemispheric transfer (multimodal sensory and motor tasks) as well as memory and attention tests were used. The results revealed some disconnection symptoms with minor clinical significance, which could not be attributed to particular sites of the corpus callosum, except the splenium. It is questionable whether the reported memory and attention impairments are caused by the callosal lesion or by extracallosal pathology. The results indicate that the transcallosal approach is a safe and feasible alternative in the management of pathological midline processes in the brain.

Adolescent↗
PubMed1988

Diseases of the intrapetrous carotid artery.

In the early years of skull base surgery, total tumor removal was often deemed impossible due to involvement of the intrapetrous carotid artery. In contrast, previously considered unresectable lesions may be removed totally in selected cases, with reasonable expectation of successful treatment at the present time. Current techniques and operative exposures, when modified to accommodate the problem of intracranial extensions of tumor and when approached with neurosurgical collaboration, permit the removal of many of these difficult tumors. This retrospective study of 33 patients treated over the past 5 years offers a critical analysis of our treatment, and a categorization of abnormalities known to affect this anatomic region containing the vessel.

Adenocarcinoma↗
PubMed1988

Solitary intracranial extracerebral glioma.

The authors present the case of a 65-year-old woman with a solitary extracerebral glioma. The tumour originated from the falx in the left fronto-parietal region near the paracentral lobule. Because it was well delineated and was completely outside the brain it was thought at operation to be a meningioma or a metastasis. Histologically the tumour could be classified as an oligodendroglioma (WHO grade II). Intracranial extracerebral gliomas so far described are most frequently located in the vicinity of the sylvian fissure. Involvement of the dura has only been observed in three cases. This case is to the best of our knowledge the only one in which the tumour was situated in the longitudinal fissure having originated from the falx. Extracerebral gliomas are thought to arise from heterotropic nests of glial cells in the leptomeninges.

Aged↗
PubMed1988

Technique, indications, and complications of percutaneous needle puncture.

One hundred and forty-five percutaneous needle punctures (PNP) of the brain and ventricles in 100 consecutive patients were retrospectively re-evaluated. This was to elucidate technical problems and complications of this method, which presents an alternative to the classical burr hole trephination with the insertion of a catheter. In 61% percutaneous needle trephinations (PNT) were performed, in 27% a pre-existing burr hole was used, and in 12% the open fontanelle. The method proved to be simple and effective, especially in emergency cases, and it had a very low rate of serious complications with 1.4% infections and 0.7% symptomatic bleedings, which had no permanent consequences.

Adolescent↗
PubMed1987

Incidence of wound infection in patients undergoing craniotomy: influence of type of shaving.

How the method of shaving affects the incidence of deep postoperative wound infections was examined in 475 patients. It is shown that the rate of infection is not lower after wet shaving than after dry shaving. The overall infection rate was 4.2%, 2.9% in patients who had been shaved wet versus 5.5% in patients shaved dry. The difference is, however, not significant on the 5% level. With respect to dry shaving, the infection rate was not affected by whether the hair was removed with electric clippers alone (2.8%) or whether a disposable razor was also used for additional hair removal in the area of skin incision (3.2%).

Craniotomy↗
PubMed1987

CT-ventriculography to control the passage of cerebrospinal fluid. Technical note.

In conventional ventriculography used to confirm free passage of cerebrospinal fluid (CSF), bony overprojections often makes it difficult to visualize the contrast medium in the cranio-spinal subarachnoid spaces. CT-ventriculography offers an alternative. Because of the high density resolution, even small amounts of contrast material can be seen in the subarachnoid spaces of the cranio-cervical region. Its usefulness is demonstrated in a series of 15 cases.

Cerebral Ventriculography↗
PubMed1986

Nimodipine and early aneurysm operation in good condition SAH patients.

A prospective open multicenter study on the preventive effect of nimodipine on symptomatic vascular spasm was performed in 120 (consecutive) patients with aneurysmal subarachnoid haemorrhage (SAH). All patients underwent early surgery (i.e. within 72 hours post SAH) and were in neurological grades I-III in Hunt and Hess. Grade IV and V as well as patients with significant intracerebral haematoma are not included. On preoperative CT, SAH was mild in 28 cases, moderate in 56 and severe in 36 cases. 25 patients (21%) were in grade I, 63 patients (53%) in grade II and 32 patients (26%) in grade III. The ruptured aneurysm was located on the anterior cerebral artery complex in 57 patients, on the internal carotid artery complex in 35, on the middle cerebral artery in 24 patients and on the basilar artery in 4 patients. After occlusion of the ruptured aneurysm, the lipophilic calcium channel blocker nimodipine was administered in the following manner: Intraoperative, topical irrigation of the exposed arteries. Intravenous infusion until day 7-14 after SAH followed by peroral medication for another week. Nimodipine was well tolerated and neither significant hypotension nor any other adverse reaction attributable to the drug was observed. Ischaemic cerebral dysfunction of delayed onset with permanent neurological deficit occurred in 2 patients (2%). Another 8 patients showed transient ischaemic symptoms. At 6 months follow-up, 93% of the patients were classified as having made a full recovery, 16% as being minimally disabled, 5% as being moderately disabled and 3% as being severely disabled. Three patients had died. The present study supports the concept that preventive nimodipine treatment may reduce delayed ischaemic deficit in early aneurysm surgery.

Administration, Topical↗
PubMed1986

[Extracranial aneurysms of the internal carotid artery--an otorhinolaryngologic problem?].

The problem of high cervical internal carotid aneurysms is demonstrated in two patients. One patient presented with a massive intermittent bleeding in the nasopharynx, the second with a sudden paralysis of the cranial nerves 9-12. 2/3 of these extracranial internal carotid aneurysms are situated at the bifurcation of the common carotid artery and 1/3 are located proximal the skull base. These aneurysms can be "congenital" or traumatic in origin or may arise as a complication of otitis media or tonsillitis. Diagnosis should be established by arteriography. Even for asymptomatic aneurysms the present therapeutic concept consists of a multidisciplinary surgical approach with attempted vascular reconstruction, since spontaneous rupture may occur at any moment.

Adult↗
PubMed1985

Use of a malar bone graft to augment skull-base access.

An anterolateral transfacial approach for tumors of the retromaxillary space, the nasopharynx, and the middle cranial fossa features a temporary removal of the malar complex and resection of the coronoid process and the pterygoid plates. Two cases demonstrate use of this approach. Results and complications are observed in six patients.

Adolescent↗
PubMed1985

Long-term effects of partial callosal lesions. Preliminary report.

Ten patients with partial callosal lesions were investigated with a broad scale neuropsychological assessment. Nine patients with a variety of lesions affecting midline structures have been operated using a direct transcallosal approach, one patient with a callosal lipoma remained unoperated. Sophisticated studies of the interhemispheric transfer of somaesthetic and perceptual motor tasks, as well as psychometric testing related to parameters of memory and attention performance were applied. The results indicate that there is no clear correlation between the site of callosal lesion and clinical symptoms. Although special disconnecting symptoms due to callosal dissection could be found, they didn't reach clinical significance. The most severe symptoms of impairment were caused by the extracallosal pathology. The results indicate that the transcallosal approach is a safe and feasible alternative in the management of pathological lesions in the midline region.

Adolescent↗