Localization of emotional and volitional facial paresis.

Emotional facial paresis is characterized by impaired activation of face muscles with emotion but normal voluntary activation. We report seven patients with this sign. Their lesions involved the frontal lobe white matter, the striatocapsular territory, the anterolateral thalamus and insula, the posterior thalamus and operculum, and the mesial temporal lobe and insula each in one patient, and the posterior thalamus in two patients. Volitional facial paresis affects facial movements with voluntary effort, sparing activation on emotion. We report four such patients, with lesions involving the motor cortex in one and the pyramidal tract in the cerebral hemisphere in three.

Decreased dopamine D2/D3-receptor binding in temporal lobe epilepsy: an [18F]fallypride PET study.

Summary: Purpose: Although animal data are suggestive, evidence for an alteration of the extrastriatal dopaminergic system in human focal epilepsy is missing. Methods: To quantify D2/D3-receptor density, we studied seven patients with temporal lobe epilepsy (TLE) and nine agematched controls with positron emission tomography (PET) by using the high-affinity dopamine D2/D3-receptor ligand [ 18 F]Fallypride ([ 18 F]FP) suitable for imaging extrastriatal binding. TLE was defined by interictal and ictal video-EEG, magnetic resonance imaging (MRI), and [ 18 F]fluorodeoxyglucose ([ 18 F]FDG)-PET and was due to hippocampal sclerosis (HS), based on histology in all patients. Primary analysis was ba…

CT and MR Imaging of Non-neoplastic Intracranial Masses

Many intracranial mass lesions of non-neoplastic origin present CT and MR features similar or identical to those of true neoplasms. In many cases a definitive diagnosis cannot be made from imaging findings alone, and misinterpretation is possible even when the history and clinical findings are considered. Yet an accurate preoperative diagnosis is an essential prerequisite for selecting candidates for a neurosurgical operation and planning the procedure. In some cases the full range of neuroradiologic techniques may have to be applied and evaluated in the context of clinical findings before the physician can accurately classify the disease and draw appropriate therapeutic conclusions.

Classification of Brain Tumors

In 1914, L. Bruns stated in Krause’s General Surgery of Brain Disorders that brain tumors include all neoplasias growing within the cranium and that they comprise three groups: (1) true tumors, (2) infectious granulomas, and (3) parasites. Current usage is more precise and is limited to the first of Bruns’ categories. Even so, brain tumors constitute a large and very heterogeneous group. A taxonomic approach to classification is necessary if we are to make sense of an initially disorganized set of observations, compare the findings of different observers, and attempt a prognostic evaluation.

Computertomographie und Kernspintomographie bei nicht tumorbedingten raumfordernden intrakraniellen Prozessen

Zahlreiche, nicht tumorbedingte raumfordernde Prozesse fuhren zu tumorahnlichen oder -identischen Darstellungen in der computertomographischen und kernspintomographischen Bildgebung. Die artspezifische Diagnose ist in vielen Fallen allein aus der Bildinterpretation nicht zu stellen. Selbst wenn die Anamnese und klinischen Befunde zur Urteilsfindung herangezogen werden, konnen Fehlinterpretationen unterlaufen. Gerade im Hinblick auf eine zielsichere Indikationsstellung fur einen neurochirurgischen Eingriff und die Wahl des chirurgischen Vorgehens ist aber eine moglichst exakte praoperative Artdiagnose erforderlich. Im Einzelfall mus also das gesamte Repertoire der Neuroradiologie ausgeschopf…

Exophthalmos and basilar impression. A contribution to differential diagnosis of endocrine orbitopathy.

We report on a male patient with exophthalmos of unclear etiology, basilar impression, syringohydromyelia and type II Arnold-Chiari malformation. Two diseases involving the orbital region were to be considered in differential diagnostic terms: endocrine orbitopathy and osseous orbit dysplasia. The typical physical appearance associated with basilar impression as well as suppurative keratitis in Lagophthalmos was striking. Tetraspasticity with pareses, bulbar symptoms, proximally pronounced muscular atrophy as well as a left hemihypesthesia was shown neurologically. Although the orbit CT was normal, sonography revealed thickened ocular muscles. There was euthyroidism in diffuse goiter with n…

Insular strokes cause no vestibular deficits.

Background and Purpose— In previous imaging studies, the posterior insular cortex (IC) was identified as an essential part for vestibular otolith perception and considered as a core region of a human vestibular cortical network. However, it is still unknown whether lesions exclusively restricted to the posterior IC suffice to provoke signs of vestibular otolith dysfunction. Thus, present data aimed to test whether patients with lesions restricted to the IC showed vestibular otolith dysfunction. Methods— We studied 10 acute unilateral stroke patients with lesions restricted to the IC which were tested for signs of vestibular otolith dysfunction, such as tilts of subjective visual vertical, …

Basics of Image Interpretation in Interventional Neuroradiology

The majority of patients with cerebral vascular diseases, demanding neuroradiological interventions are those, who present with potential life-threatening spontaneous intracranial/intracerebral haemorrhages due to cerebral aneurysms or/and arteriovenous malformations (AVMs) or with cerebral infarction due to intra-arterial thrombi in cerebral arteries. Neuroradiological procedures (interventional neuroradiology) (IN), always, performed in general anaesthesia can be divided into occluding and opening interventions.

Computertomographie und Kernspintomographie bei Prozessen im Bereich der Schädelbasis und der Schädelkalotte

Der Nutzen der Computertomographie bei der Untersuchung der Schadelbasis, insbesondere die zahlreichen diagnostischen Aspekte einschlieslich der Moglichkeit der Planung einer operativen oder strahlentherapeutischen Behandlung sind von zahlreichen Autoren schon kurz nach Einfuhrung der CT herausgestellt worden (Liliequist u. Forsell 1976; Bradac et al. 1977a, b, 1977, 1978a, b; Hammerschlag et al. 1977; Caille et al. 1977; Lohkamp et al. 1977; Huk u. Schiefer 1978; Becker et al. 1978; Weinstein et al. 1978). Aussagekraft und Grenzen der CT- und Kernspintomographie (KST) bei der Diagnose von Erkrankungen im Bereich der knochernen Schadelbasis und der Schadelkalotte werden in diesem Kapitel zu…

Technique of CT and MR Examinations

The three original groups participating in our study used the EMI Mark I scanner from 1975 to the middle of 1977 and the EMI CT 1010 scanner after mid-1977. The Siemens Somatom DR has been used in Augsburg and Berlin since 1983, and the Philips Tomoscan CT 350 in Mainz since mid-1986.

Goitrous Congenital Hypothyroidism and Hearing Impairment Associated with Mutations in the TPO and SLC26A4/PDS Genes

Abstract Context: Pendred syndrome (PS) and thyroid peroxidase (TPO) deficiency are autosomal-recessive disorders that result in thyroid dyshormonogenesis. They share congenital hypothyroidism, goiter, and an iodide organification defect as common features. Whereas the hallmark of PS is sensorineural deafness, other forms of congenital hypothyroidism may also lead to hearing impairment. Therefore, a definite diagnosis may be difficult and require molecular genetic analyses. Case Report: The propositus presented at birth with primary hypothyroidism and goiter. He also had congenital bilateral moderate hearing loss, and PS was suspected. Methods: We sequenced the SLC26A4/PDS and TPO genes in …

Superficial siderosis of the CNS as a rare differential diagnosis of chronic low back pain

Ophthalmologic Imaging Methods

CT and MR Imaging of Lesions of Skull Base and Cranial Vault

The importance of CT in examinations of the skull base, including its role in the planning of operative or radiation therapy, has long been recognized (Liliequist and Forsell 1976; Bradac et al. 1977 a, b; 1978 a, b; Hammerschlag et al. 1977; Caille et al. 1977; Lohkamp et al. 1977; Huk and Schiefer 1978; Becker et al. 1978; Weinstein et al. 1978). In the present chapter we shall review the capabilities and limitations of this modality in the diagnosis of diseases involving the bony skull base and cranial vault. A more detailed discussion of specific tumor types may be found under the appropriate headings elsewhere in the book.

CT and MR Imaging of Brain Tumors

Our clinical population numbered 8516 patients with primary and metastatic brain tumors who underwent evaluation by computed tomography at the neurosurgical and neuroradiologic departments of the Berlin, Mainz, and Munich centers from 1975 to 1986 and at the Neurosurgical Department of Augsburg Central Hospital from 1983 to 1986. Table 5 lists all the tumors having an incidence greater than 1% in the total population; 98% of the lesions were confirmed histologically (open surgery, stereotactic biopsy, autopsy). “Rare” intracranial tumors having an incidence no greater than 1% are listed in Table 6. The frequencies of the individual tumor types correlate well with the statistical data report…

CT and MR Imaging of Orbital Lesions

In the past, the diagnosis of orbital lesions manifested clinically by unilateral or bilateral proptosis and/or impaired ocular motility has relied on conventional skull films and orbital radiographs, sonography, fluorescein angiography, internal and external carotid angiography, and ophthalmic venography. The introduction of CT, however, has greatly reduced the importance of invasive diagnostic procedures (Wende et al. 1977).

Development of a Scoring System to Evaluate the Severity of Craniocervical Spinal Cord Compression in Patients with Mucopolysaccharidosis IVA (Morquio A Syndrome).

BackgroundAs spinal cord compression at the craniocervical junction (CCJ) is a life-threatening manifestation in patients with mucopolysaccharidosis (MPS) IVA, surgical decompression should be performed before damage becomes irreversible. We evaluated the diagnostic value of several examinations for determining the need for decompression surgery.MethodsWe retrospectively analysed results of clinical neurological examination, somatosensory evoked potential (SEP) and magnetic resonance imaging (MRI) in 28 MPS IVA patients. A scoring system - based on the severity of findings - was used to compare results of patients with and without indication for decompression surgery. Individual test scores…

CT Angiography as a Confirmatory Test in Brain Death

Objective: From recent studies, it remains unclear whether CT angiography could be an alternative to other established ancillary tests for the diagnosis of brain death. We examined intracranial contrast enhancement in CT angiography after clinically established brain death and compared the results with EEG and TCD findings.

How to treat tumefactive demyelinating disease?

Glioma-like inflammatory demyelinating lesions can be found in patients with pre-diagnosed multiple sclerosis, but they have also been described as an isolated disease entity. The initial diagnostic work-up usually includes a biopsy for histopathological analysis. However, even after unambiguous histopathologic classification, tumefactive lesions pose a therapeutic challenge. Until now, there have been no guidelines on how to treat patients with these rare and extreme lesion phenotypes. Here we report a patient with a relapsing unifocal tumefactive demyelinating lesion. The patient initially showed a good response to steroid treatment, with full clinical recovery. However, after relapse of…

CT-guided stereotactic biopsy aided by Doppler ultrasonic vascular monitoring

The use of a 20 MHz pulsed Doppler technique during stereotactic brain tumour biopsies is described. By means of a miniaturized ultrasonic probe the tissue planned for biopsy was investigated for vessel signals. Out of 41 patients, with this technique a flow-pulse curve in front of the biopsy cannula was registered in 14 cases. In 9 cases one pulse curve was determined and in 5 cases two or more flow curves were found, indicating the presence of arterial vessels. The depth of the vessels signal could be localized and this area avoided for biopsy sampling. In a series of 41 stereotactic biopsies carried out in this way there was no intra-operative haemorrhage or postoperative haematoma.

Evaluation of MRI and cannabinoid type 1 receptor PET templates constructed using DARTEL for spatial normalization of rat brains

Purpose: Image registration is one prerequisite for the analysis of brain regions in magnetic-resonance-imaging (MRI) or positron-emission-tomography (PET) studies. Diffeomorphic anatomical registration through exponentiated Lie algebra (DARTEL) is a nonlinear, diffeomorphic algorithm for image registration and construction of image templates. The goal of this small animal study was (1) the evaluation of a MRI and calculation of several cannabinoid type 1 (CB1) receptor PET templates constructed using DARTEL and (2) the analysis of the image registration accuracy of MR and PET images to their DARTEL templates with reference to analytical and iterative PET reconstruction algorithms. Methods:…

Vestibular thalamus: Two distinct graviceptive pathways.

Objective: To determine whether there are distinct thalamic regions statistically associated with either contraversive or ipsiversive disturbance of verticality perception measured by subjective visual vertical (SVV). Methods: We used modern statistical lesion behavior mapping on a sample of 37 stroke patients with isolated thalamic lesions to clarify which thalamic regions are involved in graviceptive otolith processing and whether there are distinct regions associated with contraversive or ipsiversive SVV deviation. Results: We found 2 distinct systems of graviceptive processing within the thalamus. Contraversive tilt of SVV was associated with lesions to the nuclei dorsomedialis, intrala…

Detection of intracranial circulatory arrest in brain death using cranial CT-angiography.

Background and purpose Computed tomographic-angiography (CT-A) is becoming more accepted in detecting intracranial circulatory arrest in brain death (BD). An international consensus about the use and the parameters of this technique is currently not established. We examined intracranial contrast enhancement in CT-A after clinically confirmed BD, compared the results with electroencephalography (EEG) and Transcranial Doppler Ultrasonography (TCD) findings and developed a commonly applicable CT-A protocol. Methods Prospective, monocentric study between April 2008 and October 2011. EEG, TCD and CT-A were performed in 63 patients aged between 18 and 88 years (mean, 55 years) who fulfilled clini…

Computertomographie und Kernspintomographie der Hirngeschwülste

Unser Krankengut umfast 8516 Patienten mit Hirntumoren und Hirnmetastasen, die an den Neurochirurgischen bzw. Neuroradiologischen Kliniken und Abteilungen Berlin, Mainz und Munchen von 1975 bis 1986 und an der Neurochirurgischen Klinik des Zentralklinikums Augsburg von 1983 bis 1986 computertomographisch untersucht wurden. In Tabelle 5 finden sich alle Tumoren mit einem Anteil von uber 1% am Gesamtkrankengut, das zu 98% bioptisch (offene Operation, stereotaktische Biopsie, Sektion) geklart ist. In Tabelle 6 wurden die seltenen intrakraniellen Tumoren weiter differenziert, wobei wir Tumoren mit einer Haufigkeit von maximal 1% als selten ansehen. Die Haufigkeiten der einzelnen Tumorarten korr…

Accuracy of stereotactic coordinate transformation using a localisation frame and computed tomographic imaging

The accuracy of coordinate transformation from the computed tomographic (CT) space to the stereotactic frame space was analysed for frame-based stereotactic systems which use a localisation frame and coordinate transformation based on matrix calculation. The coordinate transformation was divided into three consecutive steps: (1) transforming the localisation frame into the CT image built up from pixels with distinct attenuation values, (2) determining the rod centres of the localisation frame in the CT image, and (3) coordinate transformation from the image to the frame space using the centres of the rods in the image space and algebraic, matrix-based calculation. The error contribution at …

Is there a relationship between the degree of preoperative motility impairment or the muscle thickness and the outcome of strabismus surgery in patients with graves' orbitopathy after decompression surgery?

There is considerable controversy regarding the performance of strabismus surgery in patients with Graves' orbitopathy (GO). The spectrum of recommendations extends from variable dose-effect correlations for these procedures (Esser, 1994; Mourits et al., 1990; Nguyen et al., 2002) to individualized approaches such as passive intraoperative motility testing and postoperative adjustment of sutures (Lueder et al., 1992; Nguyen et al., 2002), and to local anesthesia for intraoperative assessment of active motility (Kalpadakis et al., 2004). Furthermore, prior decompression surgery is known to contribute to an unpredictable outcome (Eckstein and Esser, 2003; Esser, 1994). We retrospectively anal…

Spontanes Liquorunterdrucksyndrom

Wir berichten 11 Patienten mit orthostatischem Kopfschmerz bei spontanem Liquorunterdrucksyndrom (SLUDS). Ubelkeit und Abduzensparesen (bei 3 bzw. 2 Patienten) waren die haufigsten zusatzlichen Symptome. Zehn Patienten hatten eine Pleozytose (6 bis 43 Zellen/μl) und/oder Eiweiserhohung (581 bis 1668 mg/l) im Liquor. Die CT und/oder MRT zeigte bei 5 Patienten bifrontal betonte subdurale Hamatome oder Hygrome, die MRT bei allen 4 untersuchten Patienten eine diffuse Gadolinium-Aufnahme der Meningen, bei einem mit Kaudalverlagerung des Hirntammes. Liquorszintigraphisch (9 untersuchte Patienten) war immer ein fruher Tracer-Nachweis in der Blase und eine verminderte oder fehlende Aktivitat uber d…

Computertomographie und Kernspintomographie bei Orbitaprozessen

Fur die Diagnostik von Orbitaerkrankungen, die durch einen ein- oder doppelseitigen Exophthalmus und/oder Storungen der Bulbusmotilitat in Erscheinung treten, standen bisher neben den Rontgenaufnahmen des Schadels und der Orbita die Ultraschalluntersuchung, die Fluoreszenzangiographie, die Angiographie der A. carotis interna und externa und schlieslich die Ophthalmika-Venographie zur Verfugung. Die Einfuhrung der CT hat die Bedeutung der invasiven Untersuchungsmethoden jedoch deutlich eingeschrankt (Wende et al. 1977).

Anosognosia for hemiparesis after left-sided stroke

In patients with left-sided lesions, anosognosia for hemiparesis (AHP) seems to be a rare phenomenon. It has been discussed whether this rareness might be due to an inevitable bias due to language dysfunction and whether the left hemisphere's role for our self-awareness of motor actions thus is underestimated. By applying functional magnetic resonance imaging (fMRI) we examined whether patients with AHP following a left hemisphere stroke show a regular, left-sided or a reversed, right-sided lateralization of language functions. Only the former observation would argue for an original role of the left hemisphere in self-awareness about limb function. In a consecutive series of 44 acute left-s…

Flow cytometric analysis of T cell/monocyte ratio in clinically isolated syndrome identifies patients at risk of rapid disease progression.

Background: Multiple sclerosis is a chronic inflammatory central nervous system disease diagnosed by clinical presentation and characteristic magnetic resonance imaging findings. The role of cerebrospinal fluid (CSF) analysis has been emphasized in particular in the context of differential diagnosis in patients with a first episode suggestive of multiple sclerosis. Objective: We investigated here the potential additional value of analysis of CSF cellularity by fluorescence activated cell sorting (FACS) in the setting of a routine diagnostic work-up in our inpatient clinic. Methods: CSF cells from back-up samples from patients with suspected chronic inflammatory central nervous system disord…

Mechanical recanalization in basilar artery occlusion: The ENDOSTROKE study

Objective A study was undertaken to evaluate clinical and procedural factors associated with outcome and recanalization in endovascular stroke treatment (EVT) of basilar artery (BA) occlusion. Methods ENDOSTROKE is an investigator-initiated multicenter registry for patients undergoing EVT. This analysis includes 148 consecutive patients with BA occlusion, with 59% having received intravenous thrombolysis prior to EVT. Recanalization (defined as Thrombolysis in Cerebral Infarction [TICI] score 2b–3) and collateral status (using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral grading system) were assessed by a blinded core l…

Posterior insular cortex - a site of vestibular-somatosensory interaction?

Background In previous imaging studies the insular cortex (IC) has been identified as an essential part of the processing of a wide spectrum of perception and sensorimotor integration. Yet, there are no systematic lesion studies in a sufficient number of patients examining whether processing of vestibular and the interaction of somatosensory and vestibular signals take place in the IC. Methods We investigated acute stroke patients with lesions affecting the IC in order to fill this gap. In detail, we explored signs of a vestibular tone imbalance such as the deviation of the subjective visual vertical (SVV). We applied voxel-lesion behaviour mapping analysis in 27 patients with acute unilate…

Trochlear palsies caused by isolated trochlear schwannomas.

To describe clinical features and management of 4 patients suffering from unilateral superior oblique palsies due to MRI-documented trochlear nerve schwannomas.Chart reviews of 4 patients seen at the departments of ophthalmogy and neurology at the University of Mainz.All four patients were male, aged 36 to 72 years at initial presentation. None suffered from neurofibromatosis. The history of double vision prior presentation was 9 months to 13 years, follow-up time was 9 to 156 months. Two patients didn't receive any intervention: one remained stable over the follow-up time of 9 months. In patient #2, fourth nerve palsy was diagnosed 13 years prior to confirmation of a trochlear schwannoma b…

Auswirkungen der Computertomographie und der Kernspintomographie auf den Untersuchungsablauf bei neurologisch-neurochirurgischen Erkrankungen

Computertomographie und Kernspintomographie werden heute als die entscheidenden und zuverlassigsten Untersuchungsmethoden fur den Nachweis von Hirntumoren angesehen. Durch diese Diagnostik sind die intrakraniellen Geschwulste mit einer Sensitivitat von nahezu 100% zu erfassen. Der auserordentliche Wert beider Untersuchungsmethoden beruht dabei nicht nur auf dieser hohen Nachweisquote der Tumoren, sondern besonders auch auf ihrer Aussagekraft hinsichtlich der Bestimmung der Lagebeziehung zu lebenswichtigen Zentren, der von den Geschwulsten ausgehenden raumfordernden Wirkung und der artdiagnostischen Zuordnung (= Spezifitat).

Neuroimaging for the anesthesiologist.

Neuroimaging is essential in the treatment of cerebral nervous system disorders or in patients in the ICU with deterioration of their neurologic function. Leading clinical symptoms are acute neurologic deficits with different stages of hemisymptomatology, primary or progressing loss of consciousness or vigilance deficit, focal or generalized seizures, sometimes combined with an acute respiratory or circulatory insufficiency. The resulting questions can be summarized in those of intracranial space occupying hemorrhage; acute infarction; and signs for reduced cerebral blood flow, cerebrovascular vasospasm, or intracranial mass. Recent evolutions in imaging have contributed to an increase in d…

Impaired cortico-bulbar tract function in dysarthria due to hemispheric stroke. Functional testing using transcranial magnetic stimulation.

We investigated cortico-lingual and cortico-orofacial tract function utilizing transcranial magnetic stimulation in 18 consecutive patients with dysarthria due to hemispheric stroke. Delayed responses (conduction time > mean + 2.5 SD of that of 43 controls) or absent responses were considered abnormal. In all patients, motor-cortex stimulation of the lesion side demonstrated absent (13 patients) or delayed (five patients) responses to the tongue bilaterally (17 patients) or unilaterally (one patient). In 14 patients the contralateral orofacial responses were either absent (13 patients) or delayed (one patient). According to the electrophysiological findings, all lesions revealed by CT or MR…

Scheie syndrome: enzyme replacement therapy does not prevent progression of cervical myelopathy due to spinal cord compression.

Hurler-Scheie syndrome is caused by alpha-l-iduronidase deficiency. Enzyme replacement therapy (ERT) can improve physical capacity and reduces organomegaly. However, the effect on bradytrophic connective tissue is limited. As intravenously administered enzyme cannot cross the blood-brain barrier, the therapy of choice for the more severe Hurler syndrome is haematopoietic stem cell transplantation (HCT). In the more attenuated Scheie syndrome, neurological impairment is less severe; therefore, ERT may be appropriate to treat these patients. Information on long-term outcome in Scheie patients undergoing ERT is scarce. We report a 38-year-old female Scheie patient who has been on ERT for 8 yea…

MRI and neurophysiology in vestibular paroxysmia: contradiction and correlation

Background Vestibular paroxysmia (VP) is defined as neurovascular compression (NVC) syndrome of the eighth cranial nerve (N.VIII). The aim was to assess the sensitivity and specificity of MRI and the significance of audiovestibular testing in the diagnosis of VP. Methods 20 VP patients and, for control, 20 subjects with trigeminal neuralgia (TN) were included and underwent MRI (constructive interference in steady-state, time-of-flight MR angiography) for detection of a NVC between N.VIII and vessels. All VP patients received detailed audiovestibular testing. Results A NVC of N.VIII could be detected in all VP patients rendering a sensitivity of 100% and a specificity of 65% for the diagnosi…

Klassifikation der Hirngeschwülste

Im Rahmen der von Fedor Krause redigierten „Allgemeinen Chirurgie der Gehirnkrankheiten“ formulierte L. Bruns 1914, man rechne zu den Hirngeschwulsten alle innerhalb des Schadels sich ausdehnenden Neubildungen und konne sie in drei Gruppen teilen: 1. die echten Geschwulste, 2. die infektiosen Granulome, 3. die Parasiten. Der heutige Sprachgebrauch ist praziser und auf die erste der von Bruns aufgezahlten Gruppen eingeengt. Auch so ist ihr Bereich noch umfanglich genug und durchaus inhomogen. Erst eine taxonomische Ordnung der Bestandteile dieser Gruppe gibt einer zunachst regellosen Ansammlung von Beobachtungen eine Struktur, macht Befunde verschiedener Beobachter vergleichbar und eroffnet …

Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study.

OBJECTIVE Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for skull base procedures. The present clinical evaluation and cadaver study compare binostril and mononostril endoscopic transnasal approaches and the surgical techniques involved. METHODS Forty patients with pituitary adenomas were treated with either binostril or mononostril endoscopic surgery. Neurosurgical, endocrinological, ophthalmological, and neuroradiological examinations were performed. Ten cadaver specimens were prepared, and surgical aspects of the preparation and neuroradiological examination were documented. RESULTS In the clinical evaluation, 0° optics were optimal in the nas…

Amyloidoma of the gasserian ganglion as a cause of symptomatic neuralgia of the trigeminal nerve: report of three cases.

Three cases of symptomatic neuralgia of the trigeminal nerve due to an amyloidoma in the gasserian ganglion are described. The correct diagnosis was not made prior to histological examination of the surgical biopsy specimens. Medical history and clinical observation led to the diagnosis of a malignant process of the nasal cavities in the first patient; of an inflammatory dental focus in the second patient; and of multiple sclerosis in the third patient. CT findings were normal in cases 1 and 2; in case 3, a schwannoma was suspected from the CT appearances. In case 1, MRI had not been performed; in cases 2 and 3, MRI revealed a tumour mass which was also considered to be a schwannoma. Histol…

Impact of CT and MR on the Diagnostic Evaluation of Neurologic and Neurosurgical Diseases

Today CT and MR are considered to be the most important and most reliable methods for the diagnosis of brain tumors. The sensitivity of these modalities in the detection of intracranial tumors approaches 100%. The extraordinary value of both methods is based not only on this high detection rate but also on their ability to localize tumors in relation to vital centers, assess their mass effect, and establish the tissue type of the lesion (= specificity).

Computertomographische und kernspintomographische Untersuchungstechnik

Fur die computertomographische Untersuchung unserer Patienten standen den drei ursprunglich beteiligten CT-Arbeitsgruppen bis weit in die 80er Jahre gleiche Untersuchungsbedingungen zur Verfugung: EMI-Scanner Mark I von 1975 bis Mitte 1977, EMI-Scanner CT 1010 ab Mitte 1977, seit 1983 Siemens Somatom DR in Augsburg und Berlin, ab Mitte 1986 Philips Tomoscan CT 350 in Mainz.

Idiopathic trigeminal sensory neuropathy with gadolinium enhancement in the cisternal segment

The authors report two patients with idiopathic trigeminal sensory neuropathy who showed gadolinium enhancement of the cisternal segment of the corresponding trigeminal nerve in cranial MRI. The resolution of these lesions in a repeat MRI suggests a similarity to Bell's palsy.