Acta neurochirurgica
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Acta neurochirurgica · Jan 1995
Atypical and anaplastic meningiomas--does the new WHO-classification of brain tumours affect the indication for postoperative irradiation?
We retrospectively analysed 13 patients (pts.) treated at the University of Tübingen from 1985 to 1993 to evaluate the results of radiation therapy (XRT) given as an adjuvant to totally or subtotally resected meningiomas. The overall survival was 38% at five years with a probability of relapse of 50% at this time. Reclassification of the tumours according to the new WHO-classification of brain tumours [14] revealed 10 grade-II-tumours (atypical meningioma) and 3 grade-III-tumours (anaplastic meningioma). ⋯ Grade-III-tumours should be irradiated whatever the extent of the primary surgery was. Our results might indicate a possible indication for XRT in pts. with atypical grade-II-tumours especially when radical surgery must be in doubt. Prospective multicentre trials are warranted to prove the prognostic value of the new WHO-classification for atypical and anaplastic meningiomas and to define the ultimate role of radiotherapy in this setting.
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Acta neurochirurgica · Jan 1995
Comparative StudyBedside measurement of the third ventricle's diameter during episodes of arising intracranial pressure after head trauma. Using transcranial real-time sonography for a non-invasive examination of intracranial compensation mechanisms.
Using transcranial real-time sonography, changes in the axial diameter of the third ventricle during manoeuvres, which increased intracranial pressure (ICP), were measured in 28 patients with moderate to severe head injury. The measurements were correlated with ICP measured by epidural pressure monitoring. ⋯ We interpret that poor outcome as a measurable inability for the brain to expel cerebrospinal fluid into extracerebral compartments during increased ICP. Transcranial real-time sonography may provide additional information about intracranial cerebral fluid dynamics and compliance.
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Acta neurochirurgica · Jan 1995
Criteria for conservative treatment of supratentorial acute subdural haematomas.
Without mortality, 31 patients underwent conservative treatment for traumatic supratentorial acute subdural haematoma (SDH). Later on six of them had the haematoma surgically evacuated mainly because of a deterioration of the Glasgow Coma Scale (GCS) scores. It was found that patients with a midline shift of less than 10 mm on the computed tomography (CT) scans and with a GCS score of 15 initially might be treated conservatively under close observation, reserving urgent craniotomy and evacuation of the SDH for those with deteriorating neurological conditions. ⋯ In such cases the GCS score worsened, and surgical evacuation of the SDH became necessary. A total hospital stay of 6 to 7 days may suffice for those who have become fully conscious. Repeat CT studies before discharge should be done and a close follow-up during the first 3 to 4 weeks is advisable.
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Acta neurochirurgica · Jan 1995
Case ReportsPeri-operative complications in adult moyamoya disease.
The incidence and causes of peri-operative haemodynamic complications in adult Moyamoya disease were examined by reviewing 55 surgically treated adult patients. Ninety-nine craniotomies were performed in these patients, and eight peri-operative complications (four infarctions, two haemorrhagic infarctions and two reversible ischaemic neurological deficits without a new lesion) were seen. ⋯ Surgical factors which might be responsible for the complications were noted in three cases. Sparing vital collateral vessels and minimum brain retraction as well as avoidance of non-surgical haemodynamic risk factors are considered to be essential to prevent peri-operative haemodynamic brain damage in adult Moyamoya disease.
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Nine cases of posttraumatic primary brain stem haematoma are described. All cases presented ocular and vegetative symptoms. Hyperextension was regarded as the most likely mechanism of injury. All patients were treated conservatively; half of them with a good outcome.