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Biomedical subjects

V Rohde

Publications and source records attributed to V Rohde.

86 records · Page 5Linked to original sources
PubMed1995

Stereotactic puncture and lysis of spontaneous intracerebral hemorrhage using recombinant tissue-plasminogen activator.

We have tested a treatment protocol for intracerebral hemorrhage (ICH), consisting of stereotactic insertion of a catheter into the clot, hematoma lysis by the injection of a fibrinolytic agent, recombinant tissue-plasminogen activator (rt-PA), and closed system drainage of the liquefied clot. Fourteen patients underwent computed tomographically guided stereotactic hematoma puncture and silicone tube insertion within 72 hours of intracerebral hemorrhage. The majority (nine patients) suffered from ganglionic ICH, and the size of the hematoma ranged between 3 x 3 x 4 cm and 7 x 7 x 4 cm (mean, 5.2 x 4 x 3.6 cm). All patients had major neurological deficits with or without an impaired level of consciousness, but without signs of transtentorial herniation. The initial, then daily, dose (in milligrams) of rt-PA administered via the silicone tube equalled the maximal diameter (in centimeters) of the original and remaining clot as measured initially, then daily, by computed tomographic scan. The number of rt-PA injections was four in one patient, three in eight patients, two in four patients, and one in one patient, and the total dose of rt-PA required ranged from 5 to 16 mg (mean, 9.9 mg). After rt-PA injection, the tubing was clamped for 2 hours and then opened to drain spontaneously through a closed system against 0 cm of pressure. At follow-up 6.6 months (mean) after treatment (ranging from 3 to 13 months) and according to the Glasgow outcome score, one patient was Grade V, four were Grade IV, five were Grade III, two were Grade II, and two had died.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Intra-extradural hemangioblastoma of the cauda equina.

This is a case report of a hemangioblastoma of the cauda equina with intra-extradural extension in the form of a dumbbell tumor. For the first time diagnosis of an intra-extradural spinal hemangioblastoma was made by computerized tomography (CT) and magnetic resonance imaging (MRI). A total excision was performed with microneurosurgical techniques and application of Nd:YAG laser. Clinical appearance, neuroradiological diagnostic procedures and neurosurgical therapy of intra-extradural hemangioblastomas of the cauda equina and of spinal hemangioblastomas of other localization were compared.

Adult↗
PubMed1995

[Local thrombolytic treatment of spontaneous intracerebral hemorrhage with plasminogen activator (rt-PA). Indications and limits].

Twenty patients underwent a regimen of stereotactic puncture and consecutive local lysis with recombinant tissue plasminogen activator (rt-PA) for their spontaneous intracerebral hemorrhage (ICH). Rt-PA was administered via a stereotactically placed silicone catheter according to a hematoma-size-related formula. There was no extensive intraoperative hematoma aspiration so that the capacity of rt-PA for blood-clot lysis could be investigated. Fifteen patients were somnolent/stuporous on admission and 5 comatose, the hematoma-size ranging from 3 x 3 x 4 cm up to 7 x 4 x 4 cm (mean: 5.1 x 3.9 x 3.5 cm). Control computed tomography (CT) was performed on a daily basis, and in 19 patients the hematoma showed complete or almost complete resolution on CT within 4 days. The rt-PA dosage necessary ranged from 5 to 14 (mean: 8.5) mg. Rt-PA application was performed once in 1 patients, twice in 7, three times in 11 and four times in 1 patient. On follow-up after a mean of 7.2 months 3 patients had died (Glasgow Outcome Score--GOS I). Another was GOS II, 10 GOS III, 5 GOS IV and 1 had made an excellent recovery (GOS V). Patients who were somnolent or stuporous on admission or who exhibited secondary deterioration of their level of consciousness benefitted from the treatment protocol. Early postoperative mobilization and thereby reduction of secondary complications during the patient's stay in the intensive care unit appear to be possible. Comatose patients did not benefit from this treatment and those should be treated conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Percutaneous needle trephination. Experience in 200 cases.

For many years percutaneous needle and classic burr-hole trephination with insertion of plastic catheters for external ventricular drainage are in use. The shortcomings of the conventional puncture needles were compensated for by the development of a modified instrument in recent years. In this prospective study we tried to define advantages and disadvantages of percutaneous ventriculostomy with this modified needle in a large number of patients. We treated and followed a total number of 200 patients with external ventricular drainage for various reasons (42% obstructive hydrocephalus, 27% haematocephalus, 11% malresorptive hydrocephalus, 11% elevated ICP and 9% infections). The ventriculostomy is performed--after percutaneous trephination with a 1.5 mm drill and 1.2 mm needle under local anaesthesia as a bedside procedure. The modified blunt needle is provided with markings and a set screw which allows insertion to a prefixed depth and a sharp guide which is withdrawn after penetration of the dura. It is then bent rostrally and fixed by a plaster cast. The mean duration of drainage was 9 days (1-30 days). Mean operating time for the whole procedure including fixation and connection to the drainage system was 20 minutes. Overall complication rate was 13% (N = 26). Two intracerebral haemorrhages (1%) occurred, of which one was caused by overdrainage. Five (3%) infections in primarily not infectious cases (N = 182) were seen. Only one case of infection occurred without loosening of the needle on day 17. In 19 patients (10%) the needles had loosened. Fifteen times this complication was repaired in time and no infection occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

The extreme lateral transcondylar approach to aneurysms of the vertebrobasilar junction, the vertebral artery, and the posterior inferior cerebellar artery.

The unilateral suboccipital craniotomy is the commonly performed approach to aneurysms of the vertebrobasilar junction, the vertebral artery, and the posterior inferior cerebellar artery (PICA). Many of these aneurysms are placed anterior or anterolateral to the brain stem, necessitating brain stem retraction for adequate exposure. Small dorsolateral enlargement of the foramen magnum, partial resection of the occipital condyle, and removal of the jugular tubercle allow access to the neurovascular structures ventral to the medulla without retraction of the neuroaxis. This extreme lateral transcondylar approach was performed in 20 patients with aneurysms of the vertebrobasilar junction, the vertebral artery, and the PICA; intraoperatively, two suspected aneurysms proved to be vascular malformations. Occlusion of the aneurysm and vascular malformation was successfully performed in 16 patients, resection of the vascular malformation was achieved in 1 patient, and the vertebral artery was clipped in 3 patients with fusiform aneurysms without complications related to the extreme lateral transcondylar approach. Unobstructed exposure of the aneurysm, parent artery, and neural structures without retraction of the sensitive lower brain stem are the major advantages of the extreme lateral transcondylar approach.

Journal Article↗
PubMed1994

Microsurgical Removal of Olfactory Groove Meningiomas via the Pterional Approach.

Commonly used frontobasal approaches for microsurgical removal of olfactory groove meningiomas have certain disadvantages, such as late exposure of the neurovascular complex located dorsal to the tumor, namely, the internal carotid artery, middle cerebral artery, anterior cerebral artery, and the optic nerves. In addition, the frontal sinuses are frequently opened and there can be compression of the frontal lobes from significant spatula pressure. We report our experience with the pterional approach for these tumors in 28 patients. All patients presented with hyposmia/anosmia; 20 had personality changes and 8 had visual deficits. At surgery, after dissection of the sylvian fissure, the internal carotid artery, middle cerebral artery, anterior cerebral artery, and the homolateral optic nerve were exposed before removal of the posterior tumor parts. Reduction of focal pressure was achieved by removal of the contralateral tumor following partial resection of the falx and crista galli. Total tumor removal was obtained in all but 1 patient. One patient died of pulmonary embolism. The psychoorganic syndrome resolved in all but 1 patient; visual deficits improved in 6 patients. There were no postoperative infections. We consider the pterional approach to be superior to others for these lesions because it provides early exposure of the neurovascular complex, preservation of the frontal venous drainage, and avoidance of postoperative cerebrospinal fluid fistulae.

Journal Article↗
PubMed1994

SEP and MEP in comatose patients.

Somatosensory and motor evoked potentials (SEP and MEP) were examined in a total of 254 comatose patients in the acute phase (n = 254) and during the course of the disease (n = 67). It was the aim of this study to define the prognostic value as well as the correlation of potentials with the development of the neurological condition. Our results clearly show that in terms of prognostic value, SEP are superior to MEP, with normal findings indicating favourable outcome and absent responses an unfavourable outcome. Regarding follow-up examinations, we found that both modalities are sensitive for assessment of clinical deterioration, while improvement of the neurological status usually was not followed by improved potentials. In conclusion, SEP are a valuable parameter for predicting the outcome of comatose patients. The value of electrophysiological follow-up examinations is limited, and the use of SEP and MEP in this context may only be convenient for early assessment of neurological deterioration.

Adolescent↗
PubMed1994

Pterional approach to the contralateral orbit.

Of a total of 80 operated intraorbital lesions, 2 were located in the posterior intraconal space, medial and inferior to the optic nerve. Because they were unfavorably located for standard surgical approaches, we operated via a contralateral pterional transsphenoidal-transethmoidal route. This technique provided excellent exposure and results in these two cases of intraorbital cavernous malformations. A brief description of the approach is presented.

Adult↗
PubMed1994

Transconjunctival approach to a large cavernoma of the orbit.

Orbital tumors, particularly those within the retrobulbar space, are sometimes approached by neurosurgeons as well as by ophthalmic and by maxillofacial surgeons. There are numerous descriptions for the operative techniques applied in this area. Most lesions are attacked extracranially via a lateral orbitotomy or transcranially, with or without resection of the sphenoid bone or the orbital rim. Less traumatic approaches in patients harboring a tumor in this functionally and cosmetically important region, therefore, are desirable. We describe a microneurosurgical transconjunctival approach to a large retrobulbar cavernoma in a 59-year-old man. This technique has led to a very satisfactory result, and the operation can be performed without transient section of extraocular muscles in sections.

Conjunctiva↗
PubMed1994

Emergency ventriculostomy-experience with a new screw device: technical note.

Emergency situations, such as acute hydrocephalus or ventricular hemorrhage, require immediate and reliable treatment by ventriculostomy. The method used has to be standardized, applicable in a fast manner, and associated with only minimum risk of infection. We present a recently developed set for external ventriculostomy, which meets the above-standing requirements, and which consists of a screw with self-biting thread, a metal cannula, and a special screwdriver. Ventriculostomy can be performed easily within 2 minutes, and the system can be fixed rigidly to the skull of the patient for a period of up to several weeks. Exchange of the cannula is possible within 1 minute. The system has been used in 90 cases so far, with a rate of possible infection of 1.1%.

Adult↗
PubMed1992

The prognostic value of somatosensory and motor evoked potentials in comatose patients.

Somatosensory and motor evoked potentials (SEP and MEP) were examined in a total of 213 patients in traumatic (n = 140) and nontraumatic (n = 73) coma. It was the aim of this study to compare the prognostic value of MEP elicited by both electrical and magnetoelectric transcranial stimulation with the use of SEP alone. According to the presence or absence of responses and the duration of central conduction time, SEP and MEP obtained during Days 1 through 3 after the onset of coma were divided into four categories and correlated with the outcome of the patients, as assessed by the Glasgow Outcome Scale. Our results clearly show that in terms of prognostic value, SEP are superior to MEP, with normal findings indicating a favorable outcome and absent responses an unfavorable outcome. On the other hand, patients with normal electromyographic responses after both electrical and magnetoelectric stimulation had favorable and unfavorable outcomes about equally. Thus, unlike SEP, normal MEP do not allow any prognostic conclusions. Only the bilateral absence of MEP in response to electrical stimulation was a definitely unfavorable prognostic sign because all of these patients died. In contrast, with magnetoelectric stimulation, neither normal nor absent responses allowed any prognostic conclusions. Therefore, the prognostic value of electrically evoked motor responses is limited, and magnetoelectric stimulation cannot be recommended in this context.

Adolescent↗
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↗