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Biomedical subjects

J M Gilsbach

Publications and source records attributed to J M Gilsbach.

153 records · Page 9Linked to original sources
PubMed1987

Time course of blood velocity changes related to vasospasm in the circle of Willis measured by transcranial Doppler ultrasound.

Fifty patients with ruptured aneurysms were operated on within 72 hours after the first subarachnoid hemorrhage (SAH). To prevent symptomatic vasospasm, the patients were given the calcium channel blocker, nimodipine, intravenously (2 mg/hr) for 14 days and orally (60 mg four times daily) for another 7 days. At short intervals (at least every 3rd day) the blood flow velocity in the different segments of the circle of Willis was measured with a noninvasive transcranial Doppler ultrasonography method. Within the first 72 hours after SAH, the velocity was normal in the large branches of the circle of Willis and angiography revealed no signs of vasospasm. The Doppler frequency changes that relate to blood flow accelerated between Days 3 and 10, and maximum blood flow velocities were recorded between Days 11 and 20, with normalization occurring within the following 4 weeks. The changes showed a significant relationship to the source of SAH, the side of the operative approach, and the method of nimodipine administration. A comparison between the angiographically proven diameter of spastic arteries and the Doppler-measured blood flow velocity showed an inverse relationship in flow of the middle cerebral artery and the internal carotid artery that was statistically highly significant (p less than 0.001) while this correlation was only slightly significant in the A1 segment of the anterior cerebral artery (p = 0.054). Seven patients (14%) developed delayed ischemic deficits (DID's), which were all functionally reversible. One patient (2%) died as a result of decompensated vasospasm. Based on the information provided by Doppler measurement of the individual blood flow velocity changes due to vasospasm, preventive hypertensive treatment was introduced to improve the perfusion pressure while patients were still in an asymptomatic stage. Among the last 40 patients who were treated according to this regimen, reversible DID's were observed in only three patients (7.5%) and postoperative angiography to detect vasospasm was not necessary.

Blood Flow Velocity↗
PubMed1985

Possibilities and limits of the midline interhemispheric approach.

Based on experience in 17 children operated upon between 1978 and 1984, the possibilities and limitations of the interhemispheric parafalx approach to lesions of the anterior and posterior lateral ventricles and the third ventricle are described. The interhemispheric approach seems more advantageous than transcortical approaches since additional cortical and white matter lesions can be avoided. The limitations of visibility are the same as in transcortical approaches.

Adolescent↗
PubMed1985

Early aneurysm operation and vasospasm. Intracranial Doppler findings.

Modern ultrasonic Doppler systems enable us for the first time to carry out intraoperative and pre- and postoperative investigations of the circle of Willis. The application of Doppler in acute aneurysm surgery provided the following information: During the first 3 days following subarachnoid bleeding from a cerebral aneurysm, no signs of vasospastic reaction were found by Doppler sonography. Thereafter, 90% of all patients operated on in the acute stage demonstrated localized acceleration as a sign of vasospasm, despite prophylactic nimodipine treatment. Thirty-eight percent of the patients developed delayed ischemic deficits, which, however, were only transient. These results may indicate that early surgery and nimodipine prophylaxis may not prevent vasospasm but do reduce its consequences.

Adult↗
PubMed1984

Intraoperative Doppler and real time sonography in neurosurgery.

Ultrasound Doppler sonography with miniaturized probes and high resolution offers new possibilities of intraoperative control of neurovascular procedures. Patency, flow direction stenoses and changes in resistance can be investigated atraumatically, repeatedly and without additional preparation. In bypass and aneurysm surgery, about 10% of the cases were shown by Doppler examinations to be unsatisfactory, with stenoses and occlusions. These could be immediately corrected without loss of time. In normal cases, the information on the local haemodynamics enlarges the knowledge as to the effects of the operation and make it safer. Real time ultrasonography, which can be easily adapted to neurosurgery, is a new atraumatic tool for localizing, in two dimensions, subcortical intrinsic processes, haematomas, ventricles ect. It is useful for guided biopsies and punctures and for the centering of the dura and brain incision over the middle of the lesion, especially in microsurgical procedures.

Carotid Arteries↗
PubMed1984

[Microvascular intraoperative Doppler sonography].

The use of Doppler sonographic equipment transmitting pulsed high-frequency (20 MHz) ultrasound in conjunction with miniaturised probes, allowed recordings from small brain vessels having diameters of 1 mm and less. Experience made with this technique in clinical and experimental neurosurgery demonstrated its value in all types of neurovascular operations. Nearly 10% of the immediate results of such operations, though apparently successful or without adverse findings, eventually proved unsatisfactory on Doppler sonography only and could be subsequently corrected. The quality of arterial anastomoses performed in animal experiments as well as the various anastomotic techniques can be investigated in terms of their haemodynamic efficiency. The same holds true for cerebral arterial anastomoses in man. The patency of these anastomoses can be examined intraoperatively and necessary corrections can be made immediately. Similarly the method is most helpful in aneurysm operations by allowing to verify the clipping of the aneurysm neck and the patency of the supplying vessels.

Animals↗
PubMedDate not supplied

Surgically treated traumatic synchondrotic disruption of the odontoid process in a 15-month-old girl.

A case of traumatic synchondrotic disruption in a 15-month-old girl is reported; she was treated with interlaminar wiring of C1-C2 without grafting. Reduction of the dislocation and angulation and stability were achieved without evidence of growth disturbance. However, the child's initial poor neurological status with tetraplegia below the level of C7 remained unchanged. Besides our case, there are only three other cases in the literature of young children primarily operated on for a traumatic odontoid synchondrotic disruption. Even though the dorsal interlaminar wiring of C1-C2 without grafting is an easy and safe procedure even in the very young, the optimal form of treatment for this rare injury is still unsettled.

Bone Wires↗
PubMedDate not supplied

[Spinal cord compression by a cervical oseteocartilaginous exostosis: surgical strategy aspects].

AIM: The authors present the therapeutic management of a 12-year-old boy with known hereditary multiple exostosis syndrome (HME), who developed spinal cord compression symptoms caused by an exostosis of the C2 lamina. A perinatal brain lesion with tetraparesis delayed the recognition of the spinal cord compression substantially, which resulted in an extensive spur-like growth of the exostosis. METHOD: In comparison with already published cases, this growth pattern was rather unique and required consideration on the best surgical management. We decided to monitor the spinal cord function from positioning of the patient to skin closure and to modify the surgical steps of the laminectomy with initial lateral cutting of both hemilaminae. RESULTS: Electrophysiological monitoring helped to avoid spinal cord compression by inadequate head anteflexion during positioning. Lateral cutting of the hemilaminae C2 resulted in spontaneous extrusion of the exostosis with immediate improvement of the electrophysiological findings. The boy experienced a prompt improvement of his neurological deficits. CONCLUSION: The good surgical and clinical result confirm the value of the applied management concept.

Cervical Vertebrae↗
PubMedDate not supplied

Immediate postoperative CT contrast enhancement following surgery of cerebral tumoral lesions.

PURPOSE: Our goal was to evaluate the immediate postoperative contrast enhancement behavior of cerebral lesions and to gain further information about contrast enhancement in patients under general anesthesia. METHOD: In the early postoperative period, CT scans with the without contrast medium were performed in 46 patients. The time interval between surgery and postoperative CT imaging ranged from 1 to 7.5 h (mean 4 h). Nineteen patients were under general anesthesia during CT investigation. RESULTS: In the early postoperative period, contrast medium leakage into the tumor resection cavity was noted In 14 patients (30%). Another phenomenon that was observed was the appearance of a strong demarcation and distinct contrast of gray against white matter in 24 patients (52%). This characteristic, global contrast enhancement of the cerebral cortex, occurred in 17 of 19 patients (89%) investigated under general anesthesia. CONCLUSION: In immediate postoperative CT scans, contrast medium leakage due to extravasation of contrast medium into the tumor resection cavity can be detected early. Moreover, a global contrast enhancement of the cerebral cortex can be detected as a frequent pattern in patients investigated under general anesthesia.

Adult↗