[Intracranial complications of sinusitis sphenoidalis].
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Anti-Bacterial Agents↗
Biomedical subjects
M Tatagiba
Publications and source records attributed to M Tatagiba.
Endoscope-assisted retrosigmoid intradural suprameatal approach to the middle fossa: anatomical and surgical considerations.
INTRODUCTION: Lesions involving the posterior and middle fossa may be reached by several surgical approaches depending mostly on tumors' location and characteristics. The retrosigmoid intradural suprameatal approach has been used to remove tumors of the posterior fossa extending into Meckel's cave and the middle fossa. With large tumors, this approach may allow exposure of the oculomotor and optic nerves, the supraclinoid internal carotid and communicating posterior arteries. METHODS: Three formaldehyde-fixed specimens have been prepared on both sides using the conventional retrosigmoidal-suprameatal approach. The entire endoscopic preparations have been documented via a digital recording system, using a 5mm endoscope with a 25 degrees perspective. The authors describe the anatomical corridor and technique of the endoscope-assisted retrosigmoid intradural suprameatal approach to lesions that are located predominantly within the posterior fossa and supratentorial extension into Meckel's cave, sellar and parasellar region. CONCLUSIONS: The endoscope-assisted suprameatal approach provides exposure of the antero-medial middle fossa even in cases of skull base lesions that have not caused significant displacement of neurovascular structures.
Cadaver↗
The midline suboccipital subtonsillar approach to the hypoglossal canal: surgical anatomy and clinical application.
Primary lesions of the hypoglossal canal, such as hypoglossal schwannomas, are rare. No consensus exists with regard to the surgical approach of choice for treatment of these lesions. Usually, lateral transcondylar approaches have been used. The authors describe the surgical anatomy of the midline subtonsillar approach to the hypoglossal canal. This approach includes a midline suboccipital craniotomy, dorsal opening of the foramen magnum and elevation of ipsilateral cerebellar tonsil to expose the hypoglossal nerve and its canal. The midline subtonsillar approach permits a straight primary intradural view to the hypoglossal canal. There is no necessity of condylar resections. The surgical anatomy of the subtonsillar approach is described and illustrated by an example of a case.
Brain Neoplasms↗
Surviving glioblastoma for more than 5 years: the patient's perspective.
The authors performed a comprehensive analysis of the functional outcome of 10 patients who had survived 5 years from a diagnosis of glioblastoma. Neurologic deficits were mild in most patients, but neuropsychological testing demonstrated cognitive deficits in all patients. Depression and anxiety were common. Although most patients thought that their social functioning and work ability were impaired, little reduction in overall quality of life was perceived.
Activities of Daily Living↗
[Coma. The prognostic value of evoked potentials in patients after traumatic brain injury].
BACKGROUND: The prognosis after traumatic coma is often unclear. We investigated the prognostic value of somatosensory (SSEP) and early acoustic (EAEP) evoked potentials on comatose patients in the intensive care unit regarding long-term outcome. Different evaluation systems were investigated. METHODS: This was a retrospective analysis of 100 patients. SSEP and EAEP were examined at different times and analysed according to the Riffel score. Combinations of the different types of potentials were evaluated regarding possible improvement of outcome prediction. RESULTS: The positive predictive value of at least one missing peak V of the EAEP regarding a fatal prognosis was 83%. The negative predictive value of the EAEP was 96%. A good outcome (GOS 4+5) could be predicted by bilateral normal SSEP and EAEP with a positive predictive value of 98%. CONCLUSIONS: Early evaluation of SSEP and EAEP allows reliable prognostic predictions regarding a later outcome in patients with severe traumatic brain injury and should therefore be used more often for intensive care patients.
Brain Injuries↗
[Skull base chondrosarcoma. An interdisciplinary challenge].
BACKGROUND: Chondrosarcoma is a rare differential diagnosis of malignant tumours of the skull base. The prognosis was rated as unfavourable in articles for many years. It has, however, improved considerably in recent years. The objective of this study was to evaluate and current, new optimised treatment strategies. PATIENTS AND METHODS: We retrospectively analysed the case histories and course of four patients whom we treated for chondrosarcoma of the skull base over the past 5 years at the Freiburg Skull Base Centre. RESULTS: Because of initially mild symptoms, the patients first came for examination at an advanced stage of the tumour. All patients underwent surgery, whereby an R0-resection was barely or only questionably present. Three patients underwent radiation therapy postoperatively. All patients are currently tumour free. CONCLUSIONS: Surgical treatment with curative intent is basically the therapy of choice. Due to the usually large size of the tumour and its close relationship to relevant structures, complete resection is, however, not always possible despite advances in surgical procedures. Taking the possibility of modern adjuvant radiotherapeutic procedures into account, an incomplete, function-preserving resection is preferred to a radical and mutilating resection.
Adult↗
[Dysarthria as a cardinal neurological symptom].
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Brain Stem↗
[Massive epistaxis with haemorrhagic shock in the late phase after skull-base fracture].
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Adult↗
[Clinical pathways in endocrinology and diabetology].
Endocrinology and diabetology are disciplines with an interdisciplinary approach. Patients with diabetes or endocrine disorders are diagnosed and treated by multiple disciplines both in an outpatient or in-hospital setting. Additional diabetes-specific professions also participate in the care of diabetic patients. The development of clinical pathways and case-management in institutionalized "Diabetes Centers" and "Endocrinology Centers" as platforms of cooperation is one way to improve patient care and to pool resources. In such centers an interdisciplinary decision support within the diagnostic and therapeutic process is important. E. g., interdisciplinary case conferences expediate and intensify the necessary flow of information. This guarantees the implementation of a rational and concerted treatment according to guidelines and finally optimize the clinical pathways in a continuous process improvement.
Communication↗
Detection and prevention of the trigeminocardiac reflex during cerebellopontine angle surgery.
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Arrhythmias, Cardiac↗
[Multidisciplinary management of skull base and craniocervical chordoma].
BACKGROUND: Craniocervical chordomas often only become manifest in an advanced stage. The localisation and locally-destructive growth require a multidisciplinary diagnostic and therapeutic concept early on. The goal of the present study was to present a reproducible strategy for quality assurance. PATIENTS AND METHOD: We retrospectively analysed the hospital records of 10 consecutive patients (4 women and 6 men) whom we had treated during a period of 7 years. RESULTS: The first step in therapy was tumour resection in 9 cases. One patient initially underwent stereotactic radiation. Postoperative radiation was not included a priori, but discussed individually depending on the degree of resection, the patient's age and physical condition. After an average 5 years follow up, 100 % of patients are alive. In all patients, tumour control was achieved. CONCLUSIONS: The prognosis for patients with chordomas of the skull base has improved considerably in recent years. New technologies like intraoperative navigation and improved radiation procedures have contributed to this improvement. The basis for treatment remains, however, the greatest possible surgical exstirpation with minimal surgical morbidity. Special attention should be paid in this connection to the stability of the cervical spine and the craniocervical transition border. In advanced tumour growth, complete resection is often not possible. Proton and heavy-ion radiation are promising new forms of therapy, which can also be applied after conventional radiation has been performed. A directed multidisciplinary procedure guarantees years of survival with good quality of life in many cases.
Adult↗
Patterns of SPARC expression and basement membrane intactness at the tumour-brain border of invasive meningiomas.
The matricellular glycoprotein SPARC (secreted protein, acidic and rich in cysteine), also termed osteonectin, has been found to regulate the invasive behaviour of several tumour types by interacting with basement membrane constituents. Brain invasive meningiomas are supposed to disrupt the pial-glial basement membrane. In the present study we aimed at determining the relationship of basement membrane intactness and SPARC protein expression at the meningioma-brain border. Sections of 51 brain-invasive meningiomas (31 meningothelial meningiomas WHO grade I, 11 atypical WHO grade II, and nine anaplastic WHO grade III tumours) were immunolabelled with antibodies against SPARC, epithelial membrane antigen (EMA), collagen IV and glial fibrillary acidic protein (GFAP). Twenty-two non-invasive WHO grade I meningothelial meningiomas were included in the study for comparison. At the tumour-brain border of invasive meningiomas, spindle-shaped tumour cells expressed SPARC. The number of tumours containing SPARC+ spindle cells did not differ significantly between WHO grades. By contrast, the number of WHO grade I tumours expressing collagen IV (15/31) was highly significantly elevated when compared with WHO grade II (1/11) and WHO grade III (0/9) (both P < 0.0001). There was an inverse relationship of the presence of SPARC+ spindle cells and basement membrane material. In conclusion, the destruction of the basement membrane is correlated with meningioma malignancy grade whereas the expression of SPARC protein at the tumour-brain border is not. Destruction of the basement membrane and appearance of SPARC+ spindle cells are not coincident during the course of brain invasion by meningiomas.
Adult↗
Atypical teratoid-rhabdoid tumor spreading along the trigeminal nerve.
We here describe the case of a boy with an atypical teratoid-rhabdoid tumor (ATRT) of the 4th ventricle at 1 year of age and a local tumor recurrence at 19 months of age. Due to brainstem infiltration, only incomplete tumor resection was possible each time. High-dose chemotherapy, stem cell transplantation and irradiation resulted in complete tumor remission on a control MRI. At 8 years of age, another tumor appeared extending from the cerebellopontine angle along the right trigeminal nerve through Meckel's cave into the cavernous sinus. The trigeminal tumor was not in continuity with the primary ATRT but was located within the field of prior irradiation, neuroradiologically mimicking a schwannoma or a meningioma. The origin of the trigeminal tumor as a late metastasis of the former ATRT or as a less likely irradiation-induced secondary ATRT and the operative approach are discussed.
Brain Neoplasms↗
Trigeminocardiac reflex during skull base surgery: mechanism and management.
BACKGROUND: We study the occurrence and management of the trigeminocardiac reflex (TCR) during neurosurgical procedures for lesions of the skull base. METHOD: Two hundred patients underwent neurosurgical procedures for various skull base lesions and were evaluated retrospectively for the occurrence of the TCR during surgery. This phenomenon was defined as the onset of bradycardia lower than 60 beats/minute and hypotension with a drop in mean arterial blood pressure of 20% or more due to intra-operative manipulation or traction on the trigeminal nerve. FINDINGS: Sixteen patients (8%) had a TCR intra-operatively (7 vestibular schwannomas, 5 sphenoid wing meningiomas, 3 petroclival meningiomas, 1 intracavernous epidermoid cyst). In all 16 patients with a TCR the postoperative courses presented no complications that could be directly related to this intra-operative phenomenon. CONCLUSIONS: Due to the intracranial course of the trigeminal nerve several surgical procedures at the anterior, middle and posterior skull base may elicit the trigeminocardiac reflex. Continuous monitoring of hemodynamic parameters allows the surgeon to interrupt surgical manoeuvres immediately upon the occurrence of the TCR. This technique is sufficient for the heart rate and the arterial blood pressure to return to normal levels without the necessity of additional anticholinergic medication.
Adult↗
Meningioma of the accessory nerve extending from the jugular foramen into the parapharyngeal space.
A 35-year-old man presented with pain in the right shoulder and neck for 18 months. The neurological examination revealed complete accessory nerve palsy on the right side without further deficits. Magnetic resonance imaging showed a right parapharyngeal tumour expanding into the posterior fossa through the jugular foramen without dural attachment and absence of invasion into the middle ear cavity or internal auditory meatus. Intraoperative inspection disclosed a tumour originating from the accessory nerve. Histological diagnosis revealed a meningothelial meningioma with invasion of the epineural space. To the knowledge of the authors this is the first report of an accessory nerve meningioma in the jugular foramen associated with a posterior fossa component and extension into the parapharyngeal space.
Accessory Nerve Diseases↗
Functional regeneration of the axotomized auditory nerve with combined neurotrophic and anti-inhibitory strategies.
Injury to the mammalian auditory nerve is associated with a lack of long-distance elongation and leads to definitive loss of the hearing function. To overcome this central nervous system typical lack of functional regeneration, a combined neurotrophic and antiinhibitory treatment is applied. After complete unilateral sectioning of the auditory nerve in adult rats a combination of the Nogo-A inhibitor IN-1 and the neurotrophic factor NT-3 is administrated intrathecally into the cerebellopontine angle for one week. Functional regeneration is evaluated by measuring auditory brainstem evoked potentials for a follow-up period of up to three months. After treatment, up to forty percent of the animals showed a second vertex-positive wave in the auditory brainstem evoked potentials which occurred between three to four weeks after sectioning and remained stable during the follow-up period. A limited degree of functional regeneration of the axotomized auditory nerve is possible after application of IN-1 and NT-3. For additional improvement of functional results further investigations on combined treatments with scar reducing agents, neurotrophic factors and neuroprotective drugs remain necessary.
Animals↗
Electrically evoked hearing perception by functional neurostimulation of the central auditory system.
Perceptional benefits and potential risks of electrical stimulation of the central auditory system are constantly changing due to ongoing developments and technical modifications. Therefore, we would like to introduce current treatment protocols and strategies that might have an impact on functional results of auditory brainstem implants (ABI) in profoundly deaf patients. Patients with bilateral tumours as a result of neurofibromatosis type 2 with complete dysfunction of the eighth cranial nerves are the most frequent candidates for auditory brainstem implants. Worldwide, about 300 patients have already received an ABI through a translabyrinthine or suboccipital approach supported by multimodality electrophysiological monitoring. Patient selection is based on disease course, clinical signs, audiological, radiological and psycho-social criteria. The ABI provides the patients with access to auditory information such as environmental sound awareness together with distinct hearing cues in speech. In addition, this device markedly improves speech reception in combination with lip-reading. Nonetheless, there is only limited open-set speech understanding. Results of hearing function are correlated with electrode design, number of activated electrodes, speech processing strategies, duration of pre-existing deafness and extent of brainstem deformation. Functional neurostimulation of the central auditory system by a brainstem implant is a safe and beneficial procedure, which may considerably improve the quality of life in patients suffering from deafness due to bilateral retrocochlear lesions. The auditory outcome may be improved by a new generation of microelectrodes capable of penetrating the surface of the brainstem to access more directly the auditory neurons.
Auditory Perception↗
[Information assisted surgery as a transdisciplinary surgical procedure].
BACKGROUND: Information assisted surgery (IAS) is a further development of the computer assisted surgery (CAS) exclusively for intraoperative localization serving as basis for future technologies such as mechatronic and robotic. It requires of the surgeon a turnaround from traditional surgical proviso as well as transdisciplinary knowledge in the areas of surgical medicine, radiological imaging and information. The advantage of IAS is the predictability of the surgical procedure according to the specifications of modern quality assessment. METHOD: We analyzed the possibilities for the application of IAS in interdisciplinary transfacial surgery of the frontobasis in 9 patients with different pathologies of the central skull base and the cranio-cervical junction and compared this to conventional CAS. RESULTS: We determined retrospectively with a quality assessment analysis that surgery planning is too time consuming in the moment, and that the necessary transdisciplinary knowledge for IAS cannot be taken for granted yet. IAS has not been consequently applied for the entire surgery process in any of the 9 cases. This was due to technical difficulties as well as large intraoperative accuracy deviations of more than 5 mm. CONCLUSION: Even though the highly-developed technology of IIAS -- intelligent information assisted surgery -- is available, with the possibility of half or fully automatic implementation of IIAS including a automatic re-referencing, this technology will not be used in medical navigation for strategic reasons.
Adenoma↗