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Biomedical subjects

J Gilsbach

Publications and source records attributed to J Gilsbach.

At least 55 records · Page 3Linked to original sources
PubMed1985

Supratentorial space occupying lesions following infratentorial surgery early diagnosis and treatment.

Supratentorial complications of infratentorial surgery are rare. In the last 3 years we have operated on 187 patients with infratentorial lesions and have observed an incidence of 3.7% of supratentorial haemorrhages. Postoperative intracranial air, as shown by early postoperative CT control, was encountered mainly in a subdural frontal location and within the interhemispheric fissure. We performed no surgical decompression of the air accumulation because of the lack of clinical symptoms. Predisposing factors for the development of supratentorial complications remote from the surgical area are hypertonia, female sex, brain atrophy and preoperative shunting procedures. Measures to avoid these complications are discussed.

Adult↗
PubMed1985

[Temporary preoperative balloon catheter blockage of a traumatic giant aneurysm and of an a.v. fistula of the vertebral artery].

A new method of embolisation with a dilatation catheter is described as an example in a case with traumatic aneurysm and an a.v. fistula of the vertebral artery. The lesion was temporarily occluded with a conventional catheter for angioplasty and operated upon. The method is available for e.g. rapid management in case of imminent rupture of traumatic aneurysms, multiple lesions of vessels and for operative reconstruction of traumatised arteries.

Accidents, Home↗
PubMed1985

Transcranial Doppler sonography and its application in extracranial-intracranial bypass surgery.

Transcranial Doppler sonography is a new non-invasive technique to measure atraumatically intracranial haemodynamics. The Doppler principles and the investigative procedure with respect to the cranio-cerebral topography in normal subjects are described. Normal blood flow velocities in the circle of Willis and the influence of age and CO2-pressure are discussed in Part I. With the Doppler method, a description of the pre- and postoperative intracranial haemodynamics in patients undergoing extracranial-intracranial bypass surgery is possible for the first time. Superficial temporal artery compression tests demonstrate the contribution of the bypass to the brain circulation. Bypass surgery can be controlled without angiography. The surgeon can gain a better understanding of the haemodynamics of circulation in the brain.

Blood Flow Velocity↗
PubMed1984

Intra- and perioperative aspects of the hemodynamics of supratentorial AV-malformations.

The risks which result from hemodynamic changes after surgery of 35 patients with supratentorial arterio-venous angiomas were investigated. With the help of a miniaturized 20 MHz Doppler probe flow and resistance were measured before, during, and after operations. The Doppler findings were compared with pre- and postoperative angiograms and intraoperative surgical findings. Postoperative angiograms were performed immediately after operation. The risk of haemorrhage and oedema was found to be high in cases of large vessels with slow flow and high resistance, in high flow angiomas, in stagnating arteries visible longer than 10 s and a length more than 6 cm, and in cases of pre-operative steal. These hemodynamic risky angiomas must be treated either by multiple step-operation or hypotension.

Blood Flow Velocity↗
PubMed1984

Ultrasonographic diagnosis of brain tumors in infancy.

Fourteen intracranial tumors were diagnosed by means of mechanical sector scanning through the infant's open fontanelle in a series consisting of 1150 examinations. In addition, integrated pulsed Doppler-sonography (duplex-scan technique) was used to diagnose malformations of intracranial vessels. We established five diagnostic criteria: high echogenic structures are mostly seen in solid tumors of the periventricular region; low echogenic structures are seen in infiltrating tumors of the cerebral tissue and they are difficult to recognize; echo-free structures correspond with a cystic process, a necrosis or malformation of vessels; indirect sonographic signs of a cerebral tumor are all changes in shape and size of the normal anatomic structures; and abnormal blood-perfusion of a marked region, e.g. caused by dilatations of vessels, can be proved by integrated pulsed Doppler-sonography.

Brain Neoplasms↗
PubMed1984

[Pediatric craniocerebral injuries requiring surgical treatment].

A survey is given of the craniocerebral traumas in children necessitating surgical treatment. The particularities of craniocerebral traumas in children are contrasted to those in adult persons. Diagnostic possibilities and consequences of the injury are discussed.

Brain Injuries↗
PubMed1984

[Transcranial Doppler sonography in neurosurgery].

Using a 2 MHz transcranial Doppler sonographic system, it has become possible to measure flow velocities in the large basal vessels of the circle of Willis through thin areas of the cranial bone. After having used the method for one year on patients with neurovascular diseases, we now know that it can be employed as a matter of routine, after one has become familiar with it, and that it is of great diagnostic value. Knowing the measuring depth, achived by range gating, and with the aid of compression tests and standardised recording angles, it is possible to reliably identify the investigated vessel sections. In patients with subarachnoid haemorrhage it is possible to non-invasively detect and grade vasospasm and follow its individual course. Angiography and surgery can be reliably timed during a spasm-free interval. Preventive postoperative therapy following subarachnoid haemorrhage with hypervolaemia and hypertonia is simplified, as is the differential diagnosis as to whether secondary deteriorations are due to spasm or raised intracranial pressure. After extracranial/intracranial bypass operations, shunt patency and the effect of intracranial haemodynamics can be investigated without requiring angiography. Other fields of application concern the investigation of the evolution of haemodynamics after surgery on intracerebral arteriovenous malformations and for monitoring the cranial circulation in raised intracranial pressure.

Carotid Artery Diseases↗
PubMed1984

[Recurrence following burr hole trephination of chronic subdural hematomas].

In a consecutive series of 100 patients suffering from Chronic subdural haematomas, which were treated by burr-hole evacuation and closed external drainage, in 23 patients repeated operations became necessary. The reasons for further operations were: true recurrences in 11 cases, superimposed haematomas in five cases and haematomas on the opposite side in seven cases. All these patients were treated again by burr-hole evacuation and closed external drainage. In contrast to the common opinion craniotomy and removal of the membranes was not necessary in any case.

Aged↗
PubMed1984

[Surgical therapy of glomus jugulare tumors].

A one-stage resection of large glomus jugulare tumours with intra- and extracranial extensions is described. The patient is placed in the sitting position. Monitoring minimizes the danger of air embolism. Modifications of technique are described which reduce the intraoperative blood loss to approximately 1,000 ml.

Cranial Sinuses↗
PubMed1983

Transoral operations for craniospinal malformations.

The transoral approach to the lower third of the clivus and to the ventral aspect of the upper cervical spine is used in craniospinal malformations with or without dislocation as well as in basilar aneurysms, ventrally situated cranio-spinal tumours, fractures of the odontoid process, and in rheumatoid arthritis compressing the spinal cord. In consideration of the literature and ten personal cases the indications and techniques of the transoral approach in craniospinal malformations are discussed. According to our own experiences and those of other authors it is possible to expose the lower clivus and the cervical spine down to C2 by a midline incision of the pharyngeal wall using a mouth retractor and oral intubation. Splitting of the soft palate or resection of the hard palate are not necessary, a tracheotomy should be performed only in exceptional cases. In congenital craniospinal malformations without dislocation or instability causing a ventral compression of the spinal cord, for instance by the odontoid process, the transoral decompression is preferable to dorsal decompressing operations. In cases of pure instability without any space-occupying lesion the transoral and posterior approach are possible in order to perform a fusion. The last one seems more advantageous in these cases. In craniospinal malformations with dislocation causing a ventral and dorsal narrowing of the spinal canal, apart from the decompression a stabilization has to be achieved. In these usually complex malformations individual treatment is necessary. According to the rare cases in the literature and to our own experience a primary anterior decompression, followed by a most careful posterior stabilization seems to produce the most favourable results.

Adult↗
PubMed1983

Results and value of immediate postoperative angiography after operations for arteriovenous malformations.

Postoperative angiograms show immediate haemodynamic changes in large vessels, with a decrease in the diameter of the internal carotid artery and filling of vascular territories not previously injected. In 90% of the feeding vessels there is a disproportion between vessel lumen and flow after removal of the angioma. Mechanisms for adaptation exist, but they are inadequate in the immediate postoperative period. There is an increased risk of postoperative bleeding and brain swelling in patients with long feeding vessels, which are visible for longer than ten seconds in the angiogram.

Brain Edema↗
PubMed1983

[Sonographic detection of post-meningitis subdural effusion].

Subdural effusions in childhood are most often seen during the first year of life. In this age group two-dimensional echoencephalography gives excellent images of the brain due to the open fontanelle and the relatively low mineralisation of the cranium. The sonographic findings of two infants with postmeningeal subdural effusions are demonstrated and compared with CT-scan results. The sector-scan is much more useful than the linear-array. Computerized tomography remains necessary but it should be possible to reduce the number of examinations.

Echoencephalography↗
PubMed1982

[Two-dimensional ultrasonic examination of the cerebral ventricles (parallel-scan) in newborns and infants (author's transl)].

Computer tomography of the head is now firmly established as an examination procedure in pediatric radiology. It is non-invasive, but on the other hand time-consuming and above all costly. Repeated follow-ups represent a level of radiation exposure which should not be underestimated. Two-dimensional sonography (B-scan) has extended the range of possibilities in intracranial diagnostics in neonates and infants, especially since the large fontanelle and the still-open cranial sutures were recognized as "acoustic windows". Five cases are presented, which show that the cranial cavity can be demonstrated reliably and reproducibly, in particular the lateral ventricles. Determining vascular pulsations (real-time) aids orientation and permits conclusions to be drawn regarding the intracranial circulation. Follow-ups can be carried out simply, without submitting the child to exposure stress, and permitting early identification of a developing hydrocephalus. The examination can be performed with standard commercially available parallel-scan units, such as are already used in many clinics for abdominal diagnosis.

Cerebral Ventricles↗