Biomedical subjects
Publications and source records attributed to K Faulhauer.
100 patients who had a lumbar microdiscectomy were retrospectively compared with 100 microsurgically treated patients who had only a removal of the herniated disc fragment. We were able to show that there are less "reherniations" in the fragment removal group and the clinical outcome is often better regarding postoperative problems of instability.
A) Frequency of Far Lateral Lumbar Disc Herniation: The analysis of pre-operative computer-assisted tomograms and myelograms in a series of 694 operated lumbar disc herniations showed that a far lateral disc prolapse occured in 7% of the cases. Within the group of those far laterally herniated discs 3% of the herniations were predominantly located in the intervertebral foramen, whereas 4% of the protruded discs were mainly situated extraforaminally compressing the spinal nerve in its paravertebral course. B) Surgical Management of Extraforaminal Far Lateral Lumbar Disc Herniation: By March 1988 40 patients had been operated on for an extraforaminal disc protrusion making use of an external microsurgical exposure (in two cases by a transmuscular approach and in 38 cases via an enlarged midline approach). A medium-term follow-up of these 40 patients revealed a substantial clinical relief of pain in 34 cases (85%). Based on these gratifying results we regard the external exposure of the extraforaminally protruded disc as the treatment of choice.
Fourty-six cats were made hydrocephalic and hydromyelic by means of an intracisternal kaolin injection. In 17 other cats hydrocephalus and syringohydromyelia were achieved by operative occlusion of the foramina Luschkae of the fourth ventricle. In both the kaolin treated animals and the animals whose outlets of the fourth ventricles were operatively obstructed a progressive dilatation of the ventricles and central canal occurred, which could be demonstrated and followed in 30 animals by ventriculography, myelography and/or contrast filling of the hydromyelic central canal. Coinciding with the dilatation of the central canal the clinical picture of a raised intracranial pressure due to obstructive hydrocephalus improved. The presented results suggest that the dilated central canal acts as a kind of natural by-pass between the ventricles and the spinal subarachnoid space. In order to determine the role of spinal kaolin arachnoiditis on spinal cyst formation and central canal dilatation in 13 animals, kaolin was locally applied in the lower thoracic region. The local spinal kaolin arachnoiditis had no influence on central canal dilatation or cyst formation.
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40 adult cats were made hydrocephalic by intracisternal injection of 200 mg Kaolin. 34 survived between 24 hours to 4 months. In 19 cases a ventriculostomy was carried out, whereby in 13 animals a contrast filling of the central canal occurred. The contrast medium injected into the ventricles entered the external CSF-space in the lumbo-sacral junction of the filum terminale. Light- and electron-microscopic studies showed adaptive structural changes of the central canal epithelium in the early stages. In later stages massive destructions of ependyma and spinal cord parenchyma were found.
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In addition to the high rate of shunt complications due to obstruction and infection there is a considerable number of undesirable side effects caused by excessive drainage of CSF. Four hundred shunt treated patients are analyzed for overdrainage signs: acute decompression symptoms produced by upward shifting of the brain stem, low pressure headaches (mostly transient), and microcephaly and head deformities like scaphocephaly in infants. Skull X-ray changes reflect adjustment to reduced intracranial content. Slit ventricles and a marked intolerance to minimal pressure rises may be quite troublesome. Subdural haematomas are only exceptionally space-occupying; in most instances they are space-filling. Causes, incidence, management, and prevention are discussed.
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Between 1964 and 1974 193 infants up to the age of 2 years were treated for progressive hydrocephalus by means of a ventriculo-atrial shunt. Long term follow-up studies were possible on 148 children. Among these 94 have functioning and 54 non-functioning valves. The criteria for the non-function were based on either plain X-rays of the skull and thorax (disconnection of the catheters, distal end of the cardiac catheter above D 2), direct punctures of the antichamber and contrast medium studies of the diversional system. 35 children with non-functioning valves were normal in their mental and motor development, 9 were retarded according to their primary brain damage, 10 patients showed signs of chronic increased intracranial pressure. These results suggest, that about one fourth of the valve treated patients develop a state of valve independency.
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